Indiana § 27-13-43-5 Provisional credentialing for physicians; conditions

Indiana Statutes

§ 27-13-43-5 — Provisional credentialing for physicians; conditions

Indiana § 27-13-43-5

Title 27INSURANCE

Art. 13HEALTH MAINTENANCE ORGANIZATIONS

Ch. 43Credentialing

This text of Indiana § 27-13-43-5 (Provisional credentialing for physicians; conditions) 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 § 27-13-43-5 (2026).

Text

(a)As used in this section, "physician" refers to an individual who:

(1)is licensed under IC 25-22.5;

(2)has been granted reciprocity by the medical licensing board of Indiana under IC 25-1-21 before July 1, 2026; or

(3)is licensed in a state that has enacted the interstate medical licensure compact.

(b)If a physician who is fully credentialed by a health maintenance organization:

(1)leaves the employment of an employer and becomes employed with another employer in Indiana; or

(2)establishes or relocates a medical practice in Indiana; the health maintenance organization shall provisionally credential the physician for the time frame set forth in subsection (c).

(c)A physician under subsection (b) must be provisionally credentialed:

(1)for sixty (60) days after the physician's sepa

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(a) As used in this section, "physician" refers
to an individual who:
(1) is licensed under IC 25-22.5;
(2) has been granted reciprocity by the medical licensing board of
Indiana under IC 25-1-21 before July 1, 2026; or
(3) is licensed in a state that has enacted the interstate medical
licensure compact.
(b) If a physician who is fully credentialed by a health maintenance
organization:
(1) leaves the employment of an employer and becomes employed
with another employer in Indiana; or
(2) establishes or relocates a medical practice in Indiana;
the health maintenance organization shall provisionally credential the
physician for the time frame set forth in subsection (c).
(c) A physician under subsection (b) must be provisionally
credentialed:
(1) for sixty (60) days after the physician's separation from
employment or the establishment or relocation of the medical
practice; or
(2) until the physician is fully credentialed by the health
maintenance organization;
whichever is earlier.
(d) Notwithstanding section 2(j) of this chapter, a health
maintenance organization shall reimburse a physician who is
provisionally credentialed under this section for services rendered
while the physician was provisionally credentialed at the rates
determined by:
(1) the agreement between the physician's new employer and the
health maintenance organization relating to terms and conditions
of reimbursement; or
(2) if:
(A) the physician's new employer has not entered into an
agreement with the health maintenance organization relating to
the terms and conditions of reimbursement; or
(B) the physician established or relocated a medical practice;
the agreement between the physician and the health maintenance
organization relating to terms and conditions of reimbursement
that was in effect at the time of the physician's separation from
employment or the establishment or relocation of the medical
practice.