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Current as of January 02, 2024 | Updated by Findlaw Staff
Sec. 5. (a) As used in this section, “physician” refers to an individual who:
(1) is licensed under IC 25-22.5;
(2) has been granted reciprocity by the medical licensing board of Indiana under IC 25-1-21 before July 1, 2026; or
(3) is licensed in a state that has enacted the interstate medical licensure compact.
(b) If a physician who is fully credentialed by a health maintenance organization:
(1) leaves the employment of an employer and becomes employed with another employer in Indiana; or
(2) establishes or relocates a medical practice in Indiana;
the health maintenance organization shall provisionally credential the physician for the time frame set forth in subsection (c).
(c) A physician under subsection (b) must be provisionally credentialed:
(1) for sixty (60) days after the physician's separation from employment or the establishment or relocation of the medical practice; or
(2) until the physician is fully credentialed by the health maintenance organization;
whichever is earlier.
(d) Notwithstanding section 2(j) of this chapter, a health maintenance organization shall reimburse a physician who is provisionally credentialed under this section for services rendered while the physician was provisionally credentialed at the rates determined by:
(1) the agreement between the physician's new employer and the health maintenance organization relating to terms and conditions of reimbursement; or
(2) if:
(A) the physician's new employer has not entered into an agreement with the health maintenance organization relating to the terms and conditions of reimbursement; or
(B) the physician established or relocated a medical practice;
the agreement between the physician and the health maintenance organization relating to terms and conditions of reimbursement that was in effect at the time of the physician's separation from employment or the establishment or relocation of the medical practice.
Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-13-43-5 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-13-43-5/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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