Terms Used In Indiana Code > Title 27 > Article 1 > Chapter 37.6 - Program to Reduce or Eliminate Prior Authorization Requirements for Health Care Providers

• capitated rate reimbursement arrangement: means a fixed amount of money per patient per unit of time paid in advance to the health care provider for the delivery of health care services. See Indiana Code 27-1-37.6-2
• Contract: A legal written agreement that becomes binding when signed.
• Dependent: A person dependent for support upon another.
• downside risk: means the risk borne by health care providers in a situation in which, if the total cost of care exceeds projected or budgeted costs, the health care providers will be responsible for a defined percentage of the amount by which the total cost of care exceeds the projected or budgeted costs. See Indiana Code 27-1-37.6-3
• electronic medical records access agreement: means an agreement between a health plan and health care provider that:

  Indiana Code 27-1-37.6-5

• fixed fee schedule: means a total listing of fees used by a health plan to reimburse health care providers or facilities whether:

  Indiana Code 27-1-37.6-6

• health care provider: means an individual or entity that is:

  Indiana Code 27-1-37.6-7

• health care service: means a medical or surgical service for the diagnosis, prevention, treatment, cure, or relief of illness, injury, or disease that is measured at the diagnosis and procedure level for an individual health care provider. See Indiana Code 27-1-37.6-8
• health plan: means any of the following:

  Indiana Code 27-1-37.6-9

• Insurance: means a contract of insurance or an agreement by which one (1) party, for a consideration, promises to pay money or its equivalent or to do an act valuable to the insured upon the destruction, loss or injury of something in which the other party has a pecuniary interest, or in consideration of a price paid, adequate to the risk, becomes security to the other against loss by certain specified risks; to grant indemnity or security against loss for a consideration. See Indiana Code 27-1-2-3
• insurer: means a company, firm, partnership, association, order, society or system making any kind or kinds of insurance and shall include associations operating as Lloyds, reciprocal or inter-insurers, or individual underwriters. See Indiana Code 27-1-2-3
• pay for performance arrangement: means a reimbursement model that reimburses health care providers for meeting predefined targets as defined in the agreement for quality indicators or efficacy parameters to increase the quality or efficacy of care. See Indiana Code 27-1-37.6-11
• person: includes individuals, corporations, associations, and partnerships; personal pronoun includes all genders; the singular includes the plural and the plural includes the singular. See Indiana Code 27-1-2-3
• prior authorization: means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care service is rendered. See Indiana Code 27-1-37.6-12
• provider organization: means an entity that serves beneficiaries on a risk basis through a network of employed or affiliated providers. See Indiana Code 27-1-37.6-13