§ 27-8-16-1 — "Claim review agent" defined

Indiana § 27-8-16-1

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 16: Medical Claims Review

Text

(a) As used in this chapter, "claim review
agent" means any entity performing medical claims review on behalf
of an insurance company, a health maintenance organization, or
another benefit program providing payment, reimbursement, or
indemnification for health care costs to an enrollee.
(b) The term does not include the following:
(1) An insurance company authorized under IC 27-1-3 or IC 27-1-17 to do business in Indiana or the company's affiliated
companies.
(2) An entity acting on behalf of the federal or state government.
However, an agent described in this subdivision who performs
medical claims review for a person other than the federal or state
government is a claim review agent who is subject to the
requirements of this chapter.
(3) A health maintenance organization or limited service health
maintenance organization that holds a certificate of authority to
operate under IC 27-13.
(4) An insurance administrator that is licensed under IC 27-1-25.
(5) An individual qualified and acting as an expert witness under
the Indiana Rules of Trial Procedure.

Legislative History

As added by P.L.128-1992, SEC.2. Amended by P.L.26-1994, SEC.17; P.L.160-2003, SEC.25.