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27-8-16-9.5. Claim determinations based on data base information

IN Code § 27-8-16-9.5 (2019) (N/A)
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Sec. 9.5. (a) As used in this section, "data base" means a data base that provides information concerning health care services or amounts charged for health care services.

(b) If a claim review agent bases a medical claims review determination concerning a health care service provided by a hospital licensed under IC 12-25 or IC 16-21 in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21.

(c) If a claim review consultant makes a recommendation or provides consultation concerning the appropriateness of or the amount charged for services provided by a hospital licensed under IC 12-25 or IC 16-21 based in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21.

(d) This section does not apply to:

(1) medical claims review determinations made under subsection (b); or

(2) consultations or recommendations made under subsection (c);

regarding medical services provided under IC 22.

As added by P.L.260-1995, SEC.7.

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