§ 27-1-37.5-13 — Unanticipated, medically necessary health care service

Indiana § 27-1-37.5-13

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

Text

(a) This section applies to a claim filed
after June 30, 2025, for a medically necessary health care service
rendered by a health care provider, the necessity of which:
(1) is not anticipated at the time of scheduling another health care
service that:
(A) was authorized by the utilization review entity; or
(B) is not subject to a prior authorization requirement; and
(2) is determined at the time the other health care service is
rendered.
(b) A utilization review entity may not:
(1) require retrospective review of; or
(2) deny a claim based solely on lack of prior authorization for;
an unanticipated health care service described in subsection (a).
(c) A health care provider that renders an unanticipated health care
service described in subsection (a) shall submit to the utilization review
entity documentation explaining why the unanticipated health care
service was medically necessary.

Legislative History

As added by P.L.77-2018, SEC.2. Amended by P.L.144-2025, SEC.22.