Sec. 6. (a) As used in this chapter, “utilization review” means a system for prospective, concurrent, or retrospective review of the medical necessity and appropriateness of health care services provided or proposed to be provided to a covered individual.

     (b) The term does not include the following:

(1) Elective requests for clarification of coverage, eligibility, or benefits verification.

(2) Medical claims review (as defined in IC 27-8-16-4).

As added by P.L.128-1992, SEC.1.