Indiana § 27-1-37.5-1.8 "Clinical criteria"

Indiana Statutes

§ 27-1-37.5-1.8 — "Clinical criteria"

Indiana § 27-1-37.5-1.8

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 37.5Health Care Service Prior Authorization

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Bluebook

Ind. Code § 27-1-37.5-1.8 (2026).

Text

8. As used in this chapter, "clinical criteria" means:

(1)written policies;

(2)written screen procedures;

(3)drug formularies or lists of covered drugs;

(4)determination rules;

(5)determination abstracts;

(6)clinical protocols;

(7)practice guidelines;

(8)medical protocols; and

(9)any other criteria or rationale; used by the utilization review entity to determine the medical necessity of a health care service.

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8. As used in this chapter, "clinical criteria"
means:
(1) written policies;
(2) written screen procedures;
(3) drug formularies or lists of covered drugs;
(4) determination rules;
(5) determination abstracts;
(6) clinical protocols;
(7) practice guidelines;
(8) medical protocols; and
(9) any other criteria or rationale;
used by the utilization review entity to determine the medical necessity
of a health care service.