(a) As used in this chapter, 'utilization review' means a system for prospective, concurrent, or retrospective review of the medical necessity and appropriateness of health care services provided or proposed to be provided to a covered individual.(b) The term does not include the following:(1) Elective requests for clarification of coverage, eligibility, or benefits verification.(2) Medical claims review (as defined in IC 27-8-16-4).As added by P.L.128-1992, SEC.1.
Indiana Legal Code