§ 27-8-11-13 — Fully credentialed provider reimbursement; requirements

Indiana § 27-8-11-13

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 11: Accident and Sickness Insurance─Reimbursement

Text

(a) A fully credentialed provider shall be
reimbursed for eligible services provided at any in-network hospital if
the following conditions are met:
(1) The provider submits the documentation required by the
insurer to be loaded under the provider group or hospital.
(2) The provider, provider group, or hospital is a network provider
with the insurer.
(3) The services are provided in accordance with all terms and
conditions of the provider's, group provider's, or hospital's
agreement or contract with the insurer.
(4) Prior authorization is obtained in accordance with IC 27-1-37.5 when required by the insurer for an eligible service.
(b) The insurer shall reimburse the provider or hospital for services
described in subsection (a) at the rates determined by the contract
between the provider and the insurer.
(c) An insurer is not required to credential a provider. However, if:
(1) a provider is employed by a hospital that is part of the
hospital's network that is covered by the insurer; and
(2) the provider meets the insurer's credentialing requirements;
the insurer shall reimburse the provider for any reimbursable services
from the date that the provider was employed by the hospital.

Legislative History

As added by P.L.50-2020, SEC.8.