§ 27-1-37-5-1-5

As used in this chapter, 'adverse determination' means a denial of a request for benefits on the grounds that the health service or item:(1) is not medically necessary, appropriate, effective, or efficient;(2) is not being provided in or at an appropriate health care setting or level of care; or(3) is experimental or investigational.As added by P.L.190-2023, SEC.14.