Indiana § 27-1-37.5-19 Publishing prior authorization requirements and restrictions and
information about prior authorization approvals and denials;
implementing new or amending current prior authorization
requirements or restrictions; annual report

Indiana Statutes

§ 27-1-37.5-19 — Publishing prior authorization requirements and restrictions and information about prior authorization approvals and denials; implementing new or amending current prior authorization requirements or restrictions; annual report

Indiana § 27-1-37.5-19

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 37.5Health Care Service Prior Authorization

This text of Indiana § 27-1-37.5-19 (Publishing prior authorization requirements and restrictions and information about prior authorization approvals and denials; implementing new or amending current prior authorization requirements or restrictions; annual report) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-1-37.5-19 (2026).

Text

(a)A utilization review entity shall make any current prior authorization requirements and restrictions, including written clinical criteria, readily accessible on the utilization review entity's website to covered individuals, health care providers, and the general public. The prior authorization requirements and restrictions must be described in detail and in easily understandable language.

(b)A utilization review entity may not implement a new prior authorization requirement or restriction or amend an existing requirement or restriction unless:

(1)the utilization review entity's website has been updated to reflect the new or amended requirement or restriction; and

(2)the utilization review entity provides written notice to covered individuals and health care providers at least sixty

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(a) A utilization review entity shall make
any current prior authorization requirements and restrictions, including
written clinical criteria, readily accessible on the utilization review
entity's website to covered individuals, health care providers, and the
general public. The prior authorization requirements and restrictions
must be described in detail and in easily understandable language.
(b) A utilization review entity may not implement a new prior
authorization requirement or restriction or amend an existing
requirement or restriction unless:
(1) the utilization review entity's website has been updated to
reflect the new or amended requirement or restriction; and
(2) the utilization review entity provides written notice to covered
individuals and health care providers at least sixty (60) days
before the requirement or restriction is implemented.
(c) A utilization review entity shall make statistics available
regarding prior authorization approvals and denials on the utilization
review entity's website in a readily accessible format, including
statistics for the following categories:
(1) Health care provider specialty.
(2) Medication or diagnostic test or procedure.
(3) Indication offered.
(4) Reason for denial.
(5) If a decision was appealed.
(6) If a decision was approved or denied on appeal.
(7) The time between submission and the response.
(d) Not later than December 31 of each year, a utilization review
entity shall:
(1) prepare a report of the statistics compiled under subsection
(c); and
(2) submit the report to the department.