Sec. 8. (a) As used in this chapter, "utilization review determination" means the rendering of a decision based on utilization review that denies or affirms either of the following:
(1) The necessity or appropriateness of the allocation of resources.
(2) The provision or proposed provision of health care services to a covered individual.
(b) The term does not include the identification of alternative, optional medical care that:
(1) requires the approval of the covered individual; and
(2) does not affect coverage or benefits if rejected by the covered individual.
As added by P.L.128-1992, SEC.1.
Structure Indiana Code
Article 8. Life, Accident, and Health
Chapter 17. Health Care Utilization Review
27-8-17-1. "Covered Individual" Defined
27-8-17-2. "Department" Defined
27-8-17-4. "Health Maintenance Organization" Defined
27-8-17-5. "Provider of Record" Defined
27-8-17-6. "Utilization Review" Defined
27-8-17-7. "Utilization Review Agent" Defined
27-8-17-8. "Utilization Review Determination" Defined
27-8-17-9. Certificate of Registration; Issuance to Agent
27-8-17-10. Certificate of Registration; Renewal; Transfer; Notice of Change in Information
27-8-17-11. Minimum Utilization Review Agent Requirements
27-8-17-13. Physician's Statement; Documentation of Review Agent Capability
27-8-17-16. Fraudulent or Misleading Information; Penalties
27-8-17-18. Confidential Information