§ 27-8-17-7 — "Utilization review agent" defined

Indiana § 27-8-17-7

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 17: Health Care Utilization Review

Text

(a) As used in this chapter, "utilization review
agent" means any entity performing utilization review, except the
following:
(1) An agency of the state or federal government.
(2) An agent acting on behalf of the federal or state government.
(3) Entities conducting general in-house utilization review for
hospitals, home health agencies, health maintenance
organizations, preferred provider organizations or other managed
care entities, clinics, private offices, or any other health facility,
so long as the review does not result in the approval or denial of
an enrollee's coverage for hospital or medical services.
(b) However, an agent described in subsection (a)(2) who performs
utilization review for a person other than the federal or state
government is a utilization review agent who is subject to the
requirements of this chapter.

Legislative History

As added by P.L.128-1992, SEC.1.