Indiana § 27-8-17-8 "Utilization review determination" defined

Indiana Statutes

§ 27-8-17-8 — "Utilization review determination" defined

Indiana § 27-8-17-8

Title 27INSURANCE

Art. 8LIFE, ACCIDENT, AND HEALTH

Ch. 17Health Care Utilization Review

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Bluebook

Ind. Code § 27-8-17-8 (2026).

Text

(a)As used in this chapter, "utilization review determination" means the rendering of a decision based on utilization review that denies or affirms either of the following:

(1)The necessity or appropriateness of the allocation of resources.

(2)The provision or proposed provision of health care services to a covered individual.

(b)The term does not include the identification of alternative, optional medical care that:

(1)requires the approval of the covered individual; and

(2)does not affect coverage or benefits if rejected by the covered individual.

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(a) As used in this chapter, "utilization review
determination" means the rendering of a decision based on utilization
review that denies or affirms either of the following:
(1) The necessity or appropriateness of the allocation of
resources.
(2) The provision or proposed provision of health care services to
a covered individual.
(b) The term does not include the identification of alternative,
optional medical care that:
(1) requires the approval of the covered individual; and
(2) does not affect coverage or benefits if rejected by the covered
individual.