Terms Used In Indiana Code > Title 27 > Article 8 > Chapter 16 - Medical Claims Review

• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• 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
• claim review consultant: means a person who:

  Indiana Code 27-8-16-1.5

• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• department: refers to the department of insurance. See Indiana Code 27-8-16-2
• 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

• in writing: include printing, lithographing, or other mode of representing words and letters. See Indiana Code 1-1-4-5
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• 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
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• person: means an individual, a corporation, a limited liability company, a partnership, or an unincorporated association. See Indiana Code 27-8-16-4.5
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• 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
• Verified: when applied to pleadings, means supported by oath or affirmation in writing. See Indiana Code 1-1-4-5
• Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5