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Indiana Statutes, Title 27

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Indiana/Statutes

← All Indiana coverage

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

17 sections·Filtered byTitle 27✕Ch 52✕

Ind. Code § 27-1-52-0.3 Applicability
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Sec. 0.3. This chapter does not apply to the Medicaid program or a managed care organization (as defined in IC 12-7-2-126.9) that provides services to a Medicaid recipient. As added by P.L.88-2026, SEC.6.
Ind. Code § 27-1-52-0.5 "CARC"
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Sec. 0.5. As used in this chapter, "CARC" refers to the claim adjustment reason codes that provide the reason for a financial adjustment specified to a particular claim or service, as referenced in the transmitted Accredited Standards Committee (ASC) X12 835 standard transaction …
Ind. Code § 27-1-52-1 "Covered individual"
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Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a health plan. As added by P.L.88-2026, SEC.6.
Ind. Code § 27-1-52-10 Prohibition on downcoding based on reported diagnosis code
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Sec. 10. An insurer may not downcode a claim based solely on the reported diagnosis code. As added by P.L.88-2026, SEC.6.

Ind. Code § 27-1-52-11 Notice requirement

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Sec. 11. If a claim is downcoded, the insurer shall: (1) notify the provider using the appropriate CARC and RARC to clearly indicate that the claim has been downcoded; and (2) provide: (A) the specific reason for the downcoding, including reference to the clinical criteria used t…

Ind. Code § 27-1-52-12 Appeal process

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Sec. 12. (a) An insurer shall provide providers with a clear and accessible process for appealing downcoded claims, including: (1) a written or electronic notice detailing how to initiate an appeal; (2) contact information for the individual managing the appeal; and (3) a timelin…

Ind. Code § 27-1-52-13 Prohibition on downcoding in targeted or discriminatory manner

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Sec. 13. An insurer may not downcode in a targeted or discriminatory manner against providers that routinely treat patients with complex or chronic conditions. As added by P.L.88-2026, SEC.6.

Ind. Code § 27-1-52-14 Rules

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Sec. 14. The department shall adopt rules under IC 4-22-2 to carry out this chapter. As added by P.L.88-2026, SEC.6.

Ind. Code § 27-1-52-2 "Downcode"; "downcoding"

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Sec. 2. As used in this chapter, "downcode" or "downcoding" means the unilateral alteration by an insurer of the: (1) payment for an evaluation and management service code or other service code; or (2) level of evaluation and management service code or other service code submitte…

Ind. Code § 27-1-52-3 "Health benefits claim"

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Sec. 3. As used in this chapter, "health benefits claim" means a claim submitted by a provider for payment under a health plan for health care services provided to a covered individual. As added by P.L.88-2026, SEC.6.

Ind. Code § 27-1-52-4 "Health care service"

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Sec. 4. As used in this chapter, "health care service" means a service or good furnished for the purpose of preventing, alleviating, curing, or healing: (1) human illness; (2) physical disability; or (3) injury. As added by P.L.88-2026, SEC.6.

Ind. Code § 27-1-52-5 "Health plan"

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Sec. 5. As used in this chapter, "health plan" means the following: (1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). (2) An individual contract (as defined in IC 27-13-1-21) or a group contract (as defined in IC 27-13-1-16) with a health maintenance or…

Ind. Code § 27-1-52-6 "Insurer"

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Sec. 6. As used in this chapter, "insurer" means the following: (1) An insurer (as defined in IC 27-1-2-3(x)) that issues a policy of accident and sickness insurance (as defined in IC 27-8-5-1). (2) A health maintenance organization (as defined in IC 27-13-1-19) that provides cov…

Ind. Code § 27-1-52-7 "Provider"

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Sec. 7. As used in this chapter, "provider" means an individual or entity licensed or legally authorized to provide health care services. As added by P.L.88-2026, SEC.6.

Ind. Code § 27-1-52-7.5 "RARC"

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Sec. 7.5. As used in this chapter, "RARC" refers to remittance advice remark codes that provide: (1) supplemental information about a financial adjustment indicated by a CARC; or (2) information about remittance processing. As added by P.L.88-2026, SEC.6.

Ind. Code § 27-1-52-8 Limitation on use of downcoding by insurer

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Sec. 8. Notwithstanding any other law or regulation to the contrary, an insurer may not use downcoding in a manner that prevents a provider from: (1) submitting a health benefits claim for the actual health care service performed; and (2) collecting reimbursement from the insurer…

Ind. Code § 27-1-52-9 Limitation on use of automated process, system, or tool

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Sec. 9. (a) An insurer may not use an automated: (1) process; (2) system; or (3) tool, including artificial intelligence; as the sole basis to downcode a claim based on medical necessity without the review of the covered individual's medical record by an employee or contractor of…