Indiana § 27-8-16-8 Appeals procedure; written description; minimum standards; notice of
appeal procedure on limitation or reduction of benefits

Indiana Statutes

§ 27-8-16-8 — Appeals procedure; written description; minimum standards; notice of appeal procedure on limitation or reduction of benefits

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

(a)An insurance company, a health maintenance organization, or another benefit program providing payment, reimbursement, or indemnification for health care costs that contracts with a claim review agent for medical claims review services shall maintain and make available upon request a written description of the appeals procedure by which an enrollee may seek a review of a determination by the claim review agent.

(b)The appeals procedure referred to in subsection (a) must meet the following requirements:

(1)On appeal, the determination must be made by a provider who holds a license in the same discipline as the provider who rendered the service.

(2)The adjudication of an appeal of a determination must be completed within thirty (30) days after:

(A)the appeal is filed; and

(B)all info

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(a) An insurance company, a health
maintenance organization, or another benefit program providing
payment, reimbursement, or indemnification for health care costs that
contracts with a claim review agent for medical claims review services
shall maintain and make available upon request a written description
of the appeals procedure by which an enrollee may seek a review of a
determination by the claim review agent.
(b) The appeals procedure referred to in subsection (a) must meet
the following requirements:
(1) On appeal, the determination must be made by a provider who
holds a license in the same discipline as the provider who
rendered the service.
(2) The adjudication of an appeal of a determination must be
completed within thirty (30) days after:
(A) the appeal is filed; and
(B) all information necessary to complete the appeal is
received.
(c) If a medical review determination results in a limitation or
reduction of benefits, a notice of the appeals procedure shall be
provided by the claim review agent to the provider who rendered the
health care services.

Indiana § 27-8-16-8 (Appeals procedure; written description; minimum standards; notice of appeal procedure on limitation or reduction of benefits) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.