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Indiana Statutes, Title 27

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Indiana/Statutes

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Title 27, INSURANCE

344 chapters · 3,652 sections in this title.

All chapters in Title 273,652 Ch 1, Department Created215 Ch 2, Application of Article; Definitions199 Ch 3, General Powers and Duties of the Dep…199 Ch 4, Prohibited Activities106 Ch 6, Formation of Domestic Companies100 Ch 10, Voluntary Dissolution99 Ch 5, Classification of Insurance97 Ch 9, Merger, Consolidation, and Reinsurance97 Ch 8, Procedures for Amending Articles of …96 Ch 12, Life Insurance Company Powers and Po…92 Ch 7, General Corporate Powers and Respons…84 Ch 36, Risk Based Capital Requirements75 Ch 15, Participating Providers; Contracts a…68 Ch 13, Casualty, Fire, and Marine Insurance…66

14 sections·Filtered byTitle 27✕Ch 36.2✕

Ind. Code § 27-13-36.2-0.5 Applicability
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Sec. 0.5. Sections 4.7 and 9.5 of this chapter, as added in the 2026 session of the general assembly, and section 8 of this chapter, as amended in the 2026 session of the general assembly, apply to claims submitted under an individual contract and a group contract that: (1) is en…
Ind. Code § 27-13-36.2-1 "Clean claim" defined
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Sec. 1. As used in this chapter, "clean claim" means a claim submitted by a provider for payment for health care services provided to an enrollee that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. As added by P.L.162-2001, …
Ind. Code § 27-13-36.2-10 Prohibition on denial of claim based on out of network provider referral
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Sec. 10. (a) This section applies to an individual contract and a group contract that is entered into, delivered, amended, or renewed after June 30, 2025. (b) A health maintenance organization may not deny a claim for reimbursement for a covered service or item provided to an enr…
Ind. Code § 27-13-36.2-2 "Health maintenance organization" defined

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Sec. 2. As used in this chapter, "health maintenance organization" includes: (1) an insurance administrator that: (A) collects charges or premiums; and (B) adjusts or settles claims; in connection with coverage under a contract with a health maintenance organization; and (2) a li…

Ind. Code § 27-13-36.2-2.3 "Health provider facility"

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Sec. 2.3. As used in this chapter, "health provider facility" has the meaning set forth in IC 27-1-37-3.2. As added by P.L.88-2026, SEC.13.

Ind. Code § 27-13-36.2-3 Notice of deficiencies in claims

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Sec. 3. (a) A health maintenance organization shall pay or deny each clean claim in accordance with section 4 of this chapter. (b) A health maintenance organization shall notify a provider of any deficiencies in a submitted claim not more than: (1) thirty (30) days for a claim th…

Ind. Code § 27-13-36.2-4 Payment or denial of claims; interest

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Sec. 4. (a) A health maintenance organization shall pay or deny each clean claim as follows: (1) If the claim is filed electronically, not more than thirty (30) days after the date the claim is received by the health maintenance organization. (2) If the claim is filed on paper, n…

Ind. Code § 27-13-36.2-4.5 Prohibition on altering CPT code for claim; exceptions

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Sec. 4.5. (a) A health maintenance organization may not alter the CPT code (as defined in IC 27-1-37.5-3) submitted for a clean claim or pay for a CPT code (as defined in IC 27-1-37.5-3) of lesser monetary value unless: (1) the CPT code submitted is not in accordance with correct…

Ind. Code § 27-13-36.2-4.7 Prohibition on retroactive rate reduction; notice requirement

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Sec. 4.7. (a) A health maintenance organization may not retroactively reduce the reimbursement rate for any CPT code (as defined in IC 27-1-37.5-3). (b) A health maintenance organization shall provide at least sixty (60) days notice by: (1) mail or electronic mail to a provider; …

Ind. Code § 27-13-36.2-5 Permitted forms

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Sec. 5. A provider shall submit only the following forms for payment by a health maintenance organization: (1) CMS-1500. (2) CMS-1450 (UB-04). (3) American Dental Association (ADA) claim form. As added by P.L.162-2001, SEC.6. Amended by P.L.208-2018, SEC.32.

Ind. Code § 27-13-36.2-6 Civil penalties

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Sec. 6. (a) If the commissioner finds that a health maintenance organization has failed during any calendar year to process and pay clean claims in compliance with this chapter, the commissioner may assess an aggregate civil penalty against the health maintenance organization acc…

Ind. Code § 27-13-36.2-8 Limitations on recouping, auditing, and correcting payment errors

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Sec. 8. (a) A health maintenance organization may not, more than one hundred eighty (180) days after the date on which an overpayment on a provider claim was made to the provider by the health maintenance organization: (1) request that the provider repay the overpayment; or (2) a…

Ind. Code § 27-13-36.2-9 Claim overpayment adjustment

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Sec. 9. Every subsequent claim that is adjusted by a health maintenance organization for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including: (1) an identification of: …

Ind. Code § 27-13-36.2-9.5 Error in coordination of benefits; submission of claim to appropriate health maintenance organization

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Sec. 9.5. (a) If an insurer (as defined in IC 27-8-5.7-3) or a health maintenance organization recoups payment from a provider due to an error in coordination of benefits, the provider may submit a claim for the same services to the appropriate health maintenance organization. (b…