Indiana Code 27-1-37.5-16. Department of insurance; standardized prior authorization form
Current as of: 2023 | Check for updates
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Sec. 16. (a) Except as provided in subsection (b), the department shall establish, post, and maintain on the department’s Internet web site a standardized prior authorization form for use by health care providers and health plans for purposes of any notice or authorization required by a health plan with respect to payment for a health care service rendered to a covered individual.
(b) After December 31, 2020, a Medicaid managed care organization (as defined in IC 12-7-2-126.9) shall use a standardized prior authorization form prescribed by the office of the secretary of family and social services.
As added by P.L.77-2018, SEC.2. Amended by P.L.265-2019, SEC.4.
Terms Used In Indiana Code 27-1-37.5-16
- covered individual: means an individual who is covered under a health plan. See Indiana Code 27-1-37.5-2
- Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
- health care service: means a health care related service or product rendered or sold by a health care provider within the scope of the health care provider's license or legal authorization, including hospital, medical, surgical, mental health, and substance abuse services or products. See Indiana Code 27-1-37.5-4
- health plan: means any of the following that provides coverage for health care services:
Indiana Code 27-1-37.5-5
- prior authorization: means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care service is rendered. See Indiana Code 27-1-37.5-7