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Indiana Code Title 27. Insurance § 27-1-37.5-10

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

Sec. 10. (a) This section does not apply to prior authorization for a prescription drug.

(b) A utilization review entity shall accept a request for prior authorization delivered to the utilization review entity by a covered individual's health care provider through a secure electronic transmission or an application programming interface.  A health care provider shall submit a request for prior authorization through a secure electronic transmission or an application programming interface.  A utilization review entity shall provide for:

(1) a secure electronic transmission or an application programming interface;  and

(2) acknowledgment of receipt, by use of a transaction number or another reference code;

of a request for prior authorization and any supporting information.

(c) Subsection (b) does not apply and a utilization review entity that requires prior authorization shall accept a request for prior authorization that is not submitted through a secure electronic transmission or an application programming interface if a covered individual's health care provider and the utilization review entity have entered into an agreement under which the utilization review entity agrees to process prior authorization requests that are not submitted through a secure electronic transmission or an application programming interface because:

(1) a secure electronic transmission or an application programming interface of prior authorization requests would cause financial hardship for the health care provider;

(2) the area in which the health care provider is located lacks sufficient Internet access;  or

(3) the health care provider has an insufficient number of covered individuals as patients or customers, as determined by the commissioner, to warrant the financial expense that compliance with subsection (b) would require.

(d) If a covered individual's health care provider is described in subsection (c), the utilization review entity shall accept from the health care provider a request for prior authorization as follows:

(1) The prior authorization request must be made on the standardized prior authorization form established by the department under section 16 of this chapter.

(2) The utilization review entity shall provide for a secure electronic transmission or an application programming interface and acknowledgment of receipt of the standardized prior authorization form and any supporting information for the prior authorization by use of a transaction number or another reference code.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-1-37.5-10 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-10/

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