Terms Used In Indiana Code > Title 27 > Article 8 > Chapter 17 - Health Care Utilization Review

• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Contract: A legal written agreement that becomes binding when signed.
• covered individual: means :

  Indiana Code 27-8-17-1

• department: refers to the department of insurance. See Indiana Code 27-8-17-2
• Dependent: A person dependent for support upon another.
• enrollee: means an individual who has contracted for or who participates in coverage under an insurance policy issued under insurance classes 1(b) and 2(a) of IC 27-1-5-1, health maintenance organization contract, or other benefit program providing payment, reimbursement, or indemnification for the costs of health care for:

  Indiana Code 27-8-17-3

• health maintenance organization: has the meaning set forth in IC 27-13-1-19. See Indiana Code 27-8-17-4
• in writing: include printing, lithographing, or other mode of representing words and letters. See Indiana Code 1-1-4-5
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• provider of record: means the physician or other licensed practitioner identified to a utilization review agent as having primary responsibility for the care, treatment, and services rendered to a covered individual. See Indiana Code 27-8-17-5
• United States: includes the District of Columbia and the commonwealths, possessions, states in free association with the United States, and the territories. See Indiana Code 1-1-4-5
• 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. See Indiana Code 27-8-17-6
• utilization review agent: means any entity performing utilization review, except the following:

  Indiana Code 27-8-17-7

• utilization review determination: means the rendering of a decision based on utilization review that denies or affirms either of the following:

  Indiana Code 27-8-17-8

• Verified: when applied to pleadings, means supported by oath or affirmation in writing. See Indiana Code 1-1-4-5