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Indiana Code Title 27. Insurance § 27-8-16-8

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

Sec. 8. (a) An insurance company, a health maintenance organization, or another benefit program providing payment, reimbursement, or indemnification for health care costs that contracts with a claim review agent for medical claims review services shall maintain and make available upon request a written description of the appeals procedure by which an enrollee may seek a review of a determination by the claim review agent.

(b) The appeals procedure referred to in subsection (a) must meet the following requirements:

(1) On appeal, the determination must be made by a provider who holds a license in the same discipline as the provider who rendered the service.

(2) The adjudication of an appeal of a determination must be completed within thirty (30) days after:

(A) the appeal is filed;  and

(B) all information necessary to complete the appeal is received.

(c) If a medical review determination results in a limitation or reduction of benefits, a notice of the appeals procedure shall be provided by the claim review agent to the provider who rendered the health care services.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-8-16-8 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-16-8/

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