§ 12-15-11.5-8 — Dispute resolution procedure requirements

Indiana § 12-15-11.5-8

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 11.5: Lake County Disproportionate Share Hospitals

Text

(a) A contract entered into by a hospital
with the office's managed care organization for the provision of
services under the office's managed care program must include a
dispute resolution procedure for all disputed claims. Unless agreed to
in writing by the hospital and the office's managed care organization,
the dispute resolution procedure must include the following
requirements:
(1) That submission of disputed claims must be made to an
independent arbitrator selected under subsection (b).
(2) Each claim must set forth with specificity the issues to be
arbitrated, the amount involved, and the relief sought.
(3) That the hospital and the office's managed care organization
shall attempt in good faith to resolve all disputed claims.
(4) The hospital shall submit to the arbitrator any claims that
remain in dispute sixty (60) calendar days after the hospital
receives written notice as provided under section 7 of this chapter.
(5) That resolution of disputes by the arbitrator must occur not
later than ninety (90) calendar days after submission of disputed
claims to the arbitrator, unless the parties mutually agree
otherwise.
(6) That determinations of the arbitrator are final and binding and
not subject to any appeal or review procedure.
(7) That the arbitrator does not have the authority to award any
punitive or exemplary damages or to vary or ignore the terms of
any contract between the parties and shall be bound by controlling
law.
(8) That judgment upon the award rendered by the arbitrator may
be entered and enforced in and is subject to the jurisdiction of a
court with jurisdiction in Indiana.
(9) That the cost of the arbitrator must be shared equally by the
parties, and each party must bear its own attorney and witness
fees.
(b) The parties to a contract described in subsection (a) shall
mutually agree on an independent arbitrator, or, if the parties are
unable to reach agreement on an independent arbitrator, the following
procedure must be followed:
(1) Each party shall select an independent representative, and the
independent representatives shall select a panel of three (3)
independent arbitrators who have experience in institutional and
professional health care delivery practices and procedures and
have had no prior dealing with either party other than as an
arbitrator.
(2) The parties will each strike one (1) arbitrator from the panel
selected under subdivision (1), and the remaining arbitrator serves
as the arbitrator of the disputed claims under subsection (a).
(3) The procedures for selecting an arbitrator under this section
must be completed not later than twenty (20) calendar days after
the hospital provides written notice of at least one (1) disputed
claim.

Legislative History

As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.11.