Indiana § 27-1-37.5-23 Request for prior authorization; process

Indiana Statutes

§ 27-1-37.5-23 — Request for prior authorization; process

Indiana § 27-1-37.5-23

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 37.5Health Care Service Prior Authorization

This text of Indiana § 27-1-37.5-23 (Request for prior authorization; process) 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 § 27-1-37.5-23 (2026).

Text

(a)The time frames set forth in this section do not include weekends and state and federal legal holidays.

(b)A utilization review entity shall respond to a request for prior authorization as follows:

(1)If the request for prior authorization is for an urgent health care service, the utilization review entity shall respond with an authorization or adverse determination not later than twenty-four

(24)hours after receiving the request.

(2)If the request for prior authorization is:

(A)for a health care service other than the health care services described in subdivision (1); or

(B)for a prescription drug; the utilization review entity shall respond with an authorization or adverse determination not later than forty-eight (48) hours after receiving the request.

(c)If a utilization revi

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(a) The time frames set forth in this section
do not include weekends and state and federal legal holidays.
(b) A utilization review entity shall respond to a request for prior
authorization as follows:
(1) If the request for prior authorization is for an urgent health
care service, the utilization review entity shall respond with an
authorization or adverse determination not later than twenty-four
(24) hours after receiving the request.
(2) If the request for prior authorization is:
(A) for a health care service other than the health care services
described in subdivision (1); or
(B) for a prescription drug;
the utilization review entity shall respond with an authorization or
adverse determination not later than forty-eight (48) hours after
receiving the request.
(c) If a utilization review entity issues an adverse determination in
a response under subsection (b), the response must include the
following information:
(1) Specific reasons for the adverse determination.
(2) Suggested alternatives to the requested health care service.
(d) A health care provider shall respond not later than forty-eight
(48) hours after receiving an adverse determination under subsection
(b) if the health care provider:
(1) needs to correct a typographical, clerical, or spelling error; or
(2) accepts an alternative suggested by the utilization review
entity.
(e) Not later than forty-eight (48) hours after receiving a health care
provider's response under subsection (d), the utilization review entity
shall:
(1) render a prior authorization or adverse determination based on
the information provided in the health care provider's response;
and
(2) notify the health care provider of the authorization or adverse
determination.
(f) A health care provider may appeal an adverse determination
received under subsection (b) or (e). The health care provider shall
notify the utilization review entity of an appeal not later than
forty-eight (48) hours after receiving notice of the adverse
determination.
(g) A utilization review entity shall respond to an appeal under
subsection (f) not later than forty-eight (48) hours after receiving notice
of the appeal.