Terms Used In Indiana Code 27-1-37.6-15

• capitated rate reimbursement arrangement: means a fixed amount of money per patient per unit of time paid in advance to the health care provider for the delivery of health care services. See Indiana Code 27-1-37.6-2
• Contract: A legal written agreement that becomes binding when signed.
• downside risk: means the risk borne by health care providers in a situation in which, if the total cost of care exceeds projected or budgeted costs, the health care providers will be responsible for a defined percentage of the amount by which the total cost of care exceeds the projected or budgeted costs. See Indiana Code 27-1-37.6-3
• health care provider: means an individual or entity that is:

  Indiana Code 27-1-37.6-7

• health plan: means any of the following:

  Indiana Code 27-1-37.6-9

• pay for performance arrangement: means a reimbursement model that reimburses health care providers for meeting predefined targets as defined in the agreement for quality indicators or efficacy parameters to increase the quality or efficacy of care. See Indiana Code 27-1-37.6-11
• 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 27-1-37.6-12
• provider organization: means an entity that serves beneficiaries on a risk basis through a network of employed or affiliated providers. See Indiana Code 27-1-37.6-13