2022 Indiana Code
Title 27. Insurance
Article 1. Department of Insurance
Chapter 37.5. Health Care Service Prior Authorization
27-1-37.5-12. Claim for Which Prior Authorization Was Given; Denial; Resubmission of Claim

Universal Citation: IN Code § 27-1-37.5-12 (2022)

Sec. 12. (a) This section applies to a claim for a health care service rendered by a participating provider:

(1) for which:

(A) prior authorization is requested after December 31, 2019; and

(B) a health plan gives prior authorization; and

(2) that is rendered in accordance with:

(A) the prior authorization; and

(B) all terms and conditions of the participating provider's agreement or contract with the health plan.

(b) The health plan shall not deny the claim described in subsection (a) unless:

(1) the:

(A) request for prior authorization; or

(B) claim;

contains fraudulent or materially incorrect information; or

(2) the covered individual is not covered under the health plan on the date on which the health care service is rendered.

(c) If:

(1) the claim described in subsection (a) contains an unintentional and inaccurate inconsistency with the request for prior authorization; and

(2) the inconsistency results in denial of the claim;

the health care provider may resubmit the claim with accurate, corrected information.

As added by P.L.77-2018, SEC.2.

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