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 § 27-8-16-8

Title 27INSURANCE

Art. 8LIFE, ACCIDENT, AND HEALTH

Ch. 16Medical Claims Review

This text of Indiana § 27-8-16-8 (Appeals procedure; written description; minimum standards; notice of appeal procedure on limitation or reduction of benefits) 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 § 27-8-16-8 (2026).

Text

(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.