(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.As added by P.L.128-1992, SEC.2.
Indiana Legal Code