Indiana § 27-1-37.5-1.7 "Clinical peer"

Indiana Statutes

§ 27-1-37.5-1.7 — "Clinical peer"

Indiana § 27-1-37.5-1.7

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 37.5Health Care Service Prior Authorization

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Bluebook

Ind. Code § 27-1-37.5-1.7 (2026).

Text

7. As used in this chapter, "clinical peer" means the following:

(1)Except as provided in subdivision (3), for a review of a request from a physician, a physician who:

(A)holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered;

(B)is certified in the same specialty as the physician under review, as recognized by:

(i)the American Board of Medical Specialties; or

(ii)the American Osteopathic Association; and

(C)if the review specifically concerns subspecialty care, is certified in the same subspecialty as the physician under review, as recognized by:

(i)the American Board of Medical Specialties; or

(ii)the American Osteopathic Association.

(2)Fo

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7. As used in this chapter, "clinical peer"
means the following:
(1) Except as provided in subdivision (3), for a review of a
request from a physician, a physician who:
(A) holds a current and valid license under IC 25-22.5, has been
granted reciprocity under IC 25-1-21, if reciprocity exists, or
holds a license that is part of a compact in which Indiana has
entered;
(B) is certified in the same specialty as the physician under
review, as recognized by:
(i) the American Board of Medical Specialties; or
(ii) the American Osteopathic Association; and
(C) if the review specifically concerns subspecialty care, is
certified in the same subspecialty as the physician under
review, as recognized by:
(i) the American Board of Medical Specialties; or
(ii) the American Osteopathic Association.
(2) For a review of a request from an advanced practice registered
nurse, an advanced practice registered nurse who:
(A) holds a current and valid license under IC 25-23-1 or has
been granted reciprocity under IC 25-1-21, if reciprocity exists,
or holds a license that is part of a compact in which Indiana has
entered; and
(B) holds equivalent or similar:
(i) population focus; and
(ii) role specialty;
as the advanced practice registered nurse who is subject to the
review.
(3) For a review of a request from a primary care physician (as
defined in IC 25-22.5-5.5-1.5), a physician who:
(A) holds a current and valid license under IC 25-22.5, has been
granted reciprocity under IC 25-1-21, if reciprocity exists, or
holds a license that is part of a compact in which Indiana has
entered;
(B) is certified in the same general practice of medicine under
review, as recognized by:
(i) the American Board of Medical Specialties;
(ii) the American Board of Pediatrics; or
(iii) the American Osteopathic Association; and
(C) has been actively engaged in general practice for at least
three (3) years.
(4) For a review of a request from a practitioner or health care
provider other than those specified in subdivisions (1) through
(3), a practitioner or health care provider who:
(A) holds a current and valid license in Indiana;
(B) has been granted reciprocity in Indiana, if reciprocity exists;
or
(C) holds a license that is part of a compact in which Indiana
has entered.