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Indiana Code Title 27. Insurance § 27-1-37.5-1.7

Current as of January 02, 2024 | Updated by Findlaw Staff

Sec. 1.7. As used in this chapter, “clinical peer” means the following:

(1) Except as provided in subdivision (3), for a review of a request from a physician, a physician who:

(A) holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered;

(B) is certified in the same specialty as the physician under review, as recognized by:

(i) the American Board of Medical Specialties;  or

(ii) the American Osteopathic Association;  and

(C) if the review specifically concerns subspecialty care, is certified in the same subspecialty as the physician under review, as recognized by:

(i) the American Board of Medical Specialties;  or

(ii) the American Osteopathic Association.

(2) For a review of a request from an advanced practice registered nurse, an advanced practice registered nurse who:

(A) holds a current and valid license under IC 25-23-1 or has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered;  and

(B) holds equivalent or similar:

(i) population focus;  and

(ii) role specialty;

as the advanced practice registered nurse who is subject to the review.

(3) For a review of a request from a primary care physician (as defined in IC 25-22.5-5.5-1.5), a physician who:

(A) holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered;

(B) is certified in the same general practice of medicine under review, as recognized by:

(i) the American Board of Medical Specialties;

(ii) the American Board of Pediatrics;  or

(iii) the American Osteopathic Association;  and

(C) has been actively engaged in general practice for at least three (3) years.

(4) For a review of a request from a practitioner or health care provider other than those specified in subdivisions (1) through (3), a practitioner or health care provider who:

(A) holds a current and valid license in Indiana;

(B) has been granted reciprocity in Indiana, if reciprocity exists;  or

(C) holds a license that is part of a compact in which Indiana has entered.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-1-37.5-1.7 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-1-7/

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