Sec. 9. (a) A health plan shall make available to participating providers on the health plan’s Internet web site or portal the applicable CPT code for the specific health care services for which prior authorization is required.

     (b) A health plan shall make available to participating providers, on the health plan’s Internet web site or portal, a list of the health plan’s prior authorization requirements, including specific information that a provider must submit to establish a complete request for prior authorization. This subsection does not prevent a health plan from requiring specific additional information upon review of the request for prior authorization.

Terms Used In Indiana Code 27-1-37.5-9

  • CPT code: refers to the medical billing code that applies to a specific health care service, as published in the Current Procedural Terminology code set maintained by the American Medical Association. See Indiana Code 27-1-37.5-3
  • health plan: means any of the following that provides coverage for health care services:

    Indiana Code 27-1-37.5-5

  • participating provider: refers to the following:

    Indiana Code 27-1-37.5-6

  • 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
  • United States: includes the District of Columbia and the commonwealths, possessions, states in free association with the United States, and the territories. See Indiana Code 1-1-4-5
     (c) A health plan shall, not less than forty-five (45) days before the prior authorization requirement becomes effective, disclose to a participating provider any new prior authorization requirement.

     (d) A disclosure made under subsection (c) must:

(1) be sent via electronic or United States mail and conspicuously labeled “Notice of Changes to Prior Authorization Requirements”; and

(2) specifically identify the location on the health plan’s Internet web site or portal of the new prior authorization requirement.

However, a health plan is considered to have met the requirements of this subsection if the health plan conspicuously posts the information required by this subsection, including the effective date of the new prior authorization requirement, on the health plan’s Internet web site.

     (e) A participating provider shall, not more than seven (7) days after the change is made, notify the health plan of a change in the participating provider’s electronic or United States mail address.

As added by P.L.77-2018, SEC.2.

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