§ 27-1-37.5-10 — Request for prior authorization; electronic transmission or application programming interface; standardized form

Indiana § 27-1-37.5-10

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 1: DEPARTMENT OF INSURANCE
• Ch. 37.5: Health Care Service Prior Authorization

Text

(a) This section does not apply to prior
authorization for a prescription drug.
(b) A utilization review entity shall accept a request for prior
authorization delivered to the utilization review entity by a covered
individual's health care provider through a secure electronic
transmission or an application programming interface. A health care
provider shall submit a request for prior authorization through a secure
electronic transmission or an application programming interface. A
utilization review entity shall provide for:
(1) a secure electronic transmission or an application
programming interface; and
(2) acknowledgment of receipt, by use of a transaction number or
another reference code;
of a request for prior authorization and any supporting information.
(c) Subsection (b) does not apply and a utilization review entity that
requires prior authorization shall accept a request for prior
authorization that is not submitted through a secure electronic
transmission or an application programming interface if a covered
individual's health care provider and the utilization review entity have
entered into an agreement under which the utilization review entity
agrees to process prior authorization requests that are not submitted
through a secure electronic transmission or an application
programming interface because:
(1) a secure electronic transmission or an application
programming interface of prior authorization requests would
cause financial hardship for the health care provider;
(2) the area in which the health care provider is located lacks
sufficient Internet access; or
(3) the health care provider has an insufficient number of covered
individuals as patients or customers, as determined by the
commissioner, to warrant the financial expense that compliance
with subsection (b) would require.
(d) If a covered individual's health care provider is described in
subsection (c), the utilization review entity shall accept from the health
care provider a request for prior authorization as follows:
(1) The prior authorization request must be made on the
standardized prior authorization form established by the
department under section 16 of this chapter.
(2) The utilization review entity shall provide for a secure
electronic transmission or an application programming interface
and acknowledgment of receipt of the standardized prior
authorization form and any supporting information for the prior
authorization by use of a transaction number or another reference
code.

Legislative History

As added by P.L.77-2018, SEC.2. Amended by P.L.208-2018, SEC.8; P.L.144-2025, SEC.19.