Sec. 19. The compensation of a utilization review agent for the performance of utilization review may not be based on:

(1) the extent to which certifications are denied; or

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Terms Used In Indiana Code 27-8-17-19

  • 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
(2) the amount by which subsequent claims are reduced for payment.

As added by P.L.128-1992, SEC.1.