Indiana Code 27-8-17-13. Physician’s statement; documentation of review agent capability
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Terms Used In Indiana Code 27-8-17-13
- Contract: A legal written agreement that becomes binding when signed.
- 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
Sec. 13. To provide documentation demonstrating that a utilization review agent is capable of satisfying the requirement of section 11(7) of this chapter, as required by section 9(b)(3) of this chapter, the utilization review agent may provide a signed statement of a physician employed by or under contract to the utilization review agent verifying that determinations made by the utilization review agent as to the necessity or appropriateness of admissions, services, and procedures are reviewed by a physician or determined in accordance with standards or guidelines approved by a physician.
As added by P.L.128-1992, SEC.1.