Indiana Code 27-8-16-9. Provider’s statement; documentation of review agent capability
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Sec. 9. To provide documentation demonstrating that a claim review agent is capable of satisfying the requirement of section 7(6) of this chapter, the claim review agent must provide a signed statement of a provider employed by the claim review agent verifying that determinations are:
(2) determined in accordance with standards or guidelines approved by;
(1) made by; or
Terms Used In Indiana Code 27-8-16-9
- claim review agent: means any entity performing medical claims review on behalf of an insurance company, a health maintenance organization, or another benefit program providing payment, reimbursement, or indemnification for health care costs to an enrollee. See Indiana Code 27-8-16-1
a provider licensed in the same discipline as the provider who rendered the service.
As added by P.L.128-1992, SEC.2.