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Indiana Code Title 27. Insurance § 27-1-37.5-19

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

Sec. 19. (a) A utilization review entity shall make any current prior authorization requirements and restrictions, including written clinical criteria, readily accessible on the utilization review entity's website to covered individuals, health care providers, and the general public.  The prior authorization requirements and restrictions must be described in detail and in easily understandable language.

(b) A utilization review entity may not implement a new prior authorization requirement or restriction or amend an existing requirement or restriction unless:

(1) the utilization review entity's website has been updated to reflect the new or amended requirement or restriction;  and

(2) the utilization review entity provides written notice to covered individuals and health care providers at least sixty (60) days before the requirement or restriction is implemented.

(c) A utilization review entity shall make statistics available regarding prior authorization approvals and denials on the utilization review entity's website in a readily accessible format, including statistics for the following categories:

(1) Health care provider specialty.

(2) Medication or diagnostic test or procedure.

(3) Indication offered.

(4) Reason for denial.

(5) If a decision was appealed.

(6) If a decision was approved or denied on appeal.

(7) The time between submission and the response.

(d) Not later than December 31 of each year, a utilization review entity shall:

(1) prepare a report of the statistics compiled under subsection (c);  and

(2) submit the report to the department.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-1-37.5-19 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-19/

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