Title 27, INSURANCE

Sec. 13. As used in this chapter, "provider organization" means an entity that serves beneficiaries on a risk basis through a network of employed or affiliated providers. As added by P.L.203-2023, SEC.19.

Sec. 14. For the purposes of this chapter, a health care service that is assigned a unique CPT code or combination of CPT codes to be used for the care of a patient with a specific diagnosis is the "same health care service" as another health care service that is assigned the sam…

Sec. 15. (a) As used in this chapter, "value based health care reimbursement agreement" may include the following: (1) An accountable care organization that has a contract with a health plan in which the health plan: (A) does not assume risk for prior authorization to a provider …

Sec. 16. A health care provider that enters into: (1) a value based health care reimbursement agreement; and (2) an electronic medical records access agreement; with a health plan may qualify to participate in a program established by the health plan to reduce or eliminate prior …

Sec. 17. (a) A health plan shall notify a health care provider of any requirements that a health care provider must meet to participate in a program under section 16 of this chapter. (b) If a health plan determines that a health care provider is qualified to participate in a prog…

Sec. 18. This chapter does not preclude a health plan from requiring a health care provider to provide additional information to the health plan about health care services rendered to the health plan's members. As added by P.L.203-2023, SEC.19.

Sec. 2. As used in this chapter, "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. As added by P.L.203-2023, SEC.19.

Sec. 3. As used in this chapter, "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…

Sec. 4. As used in this chapter, "electronic medical record": (1) means a digital collection of medical information about a person that is stored on a computer, electronic platform, or cloud that is automated or permitted to be accessed; and (2) includes information about a patie…

Sec. 5. As used in this chapter, "electronic medical records access agreement" means an agreement between a health plan and health care provider that: (1) authorizes the health plan to access the provider's electronic medical records; or (2) allows the transfer of automated medic…

Sec. 6. As used in this chapter, "fixed fee schedule" means a total listing of fees used by a health plan to reimburse health care providers or facilities whether: (1) the fixed fee schedule is based on or equal to Medicare reimbursement for the same health care service; or (2) t…

Sec. 7. As used in this chapter, "health care provider" means an individual or entity that is: (1) licensed, certified, registered, or regulated by an entity described in IC 25-0.5-11; (2) authorized to provide health care services; and (3) contracted to provide health care servi…

Sec. 8. (a) As used in this chapter, "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. (b…

Sec. 9. (a) As used in this chapter, "health plan" means any of the following: (1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(a). (2) A contract with a health maintenance org…