§ 27-1-37.3-7 — Granting access to contracted health care services; requirements

Indiana § 27-1-37.3-7

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 1: DEPARTMENT OF INSURANCE
• Ch. 37.3: Third Party Rights and Responsibilities Under Health

Text

A contractor may not lease, rent, or otherwise
grant access to a provider's health care services under a health care
contract unless the contractor complies with one (1) of the following:
(1) The third party to which the access is granted is:
(A) an employer or another entity providing coverage for health
care services to the employer's or entity's employees or
members and the entity has a contract with the contractor or the
contractor's affiliate for the administration or processing of
claims for payment or service provided under the health care
contract; or
(B) an affiliate or a subsidiary of the contractor or providing
administrative services to or receiving administrative services
from the contractor or the contractor's affiliate or subsidiary.
(2) The:
(A) health care contract specifically states that the contractor
may lease, rent, or otherwise grant access to the provider's
health care services under the health care contract;
(B) third party accessing the health care contract is:
(i) a payer or third party administrator or another entity that
administers claims on behalf of the payer;
(ii) a preferred provider organization or preferred provider
network, including a physician-hospital organization; or
(iii) an entity engaged in the electronic claims transport
between the contractor and the payer; and
(C) third party that is granted access to the provider's health
care services under the health care contract is obligated to
comply with all the applicable terms of the health care contract.

Legislative History

As added by P.L.55-2008, SEC.1.