Indiana Code 27-8-16-0.5. Applicability of chapter
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Sec. 0.5. (a) This chapter applies to the following:
(2) A person who acts as a claim review consultant concerning the:
(1) A person who conducts medical claims review concerning health care services delivered to an enrollee in Indiana.
Terms Used In Indiana Code 27-8-16-0.5
- claim review consultant: means a person who:
Indiana Code 27-8-16-1.5
- enrollee: means an individual who has contracted for or who participates in coverage under an insurance policy, a health maintenance organization contract, or another benefit program providing payment, reimbursement, or indemnification for the costs of health care for:
Indiana Code 27-8-16-3
- medical claims review: means the determination of the reimbursement to be provided under the terms of an insurance policy, a health maintenance organization contract, or another benefit program providing payment, reimbursement, or indemnification for health care costs based on the appropriateness of health care services or the amount charged for a health care service delivered to an enrollee. See Indiana Code 27-8-16-4
- person: means an individual, a corporation, a limited liability company, a partnership, or an unincorporated association. See Indiana Code 27-8-16-4.5
(A) appropriateness of; or
(B) amount charged for;
a health care service delivered to an enrollee in Indiana.
(b) This chapter does not apply to:
(1) the payment of benefits or compensation;
(2) the furnishing of medical, surgical, hospital, or nursing services; or
(3) the payment by an insurer or employer to the provider of health care services for services provided;
under IC 22.
As added by P.L.260-1995, SEC.1.