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344 chapters · 3,652 sections in this title.
Ind. Code § 27-1-37.5-20 Use of clinical peer when an adverse determination is made or when reviewing or deciding an appeal
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Sec. 20. (a) A utilization review entity must ensure that: (1) all: (A) adverse determinations based on medical necessity are made; and (B) appeals are reviewed and decided; by a clinical peer; and (2) when making an adverse determination based on medical necessity or reviewing a…
Ind. Code § 27-1-37.5-21 Clinical peer's duty to a covered individual
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Sec. 21. A clinical peer who: (1) makes an adverse determination; or (2) reviews and decides an appeal; owes a duty to the covered individual to exercise the applicable standard of care. As added by P.L.144-2025, SEC.30.
Ind. Code § 27-1-37.5-23 Request for prior authorization; process
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Sec. 23. (a) The time frames set forth in this section do not include weekends and state and federal legal holidays. (b) A utilization review entity shall respond to a request for prior authorization as follows: (1) If the request for prior authorization is for an urgent health c…
Ind. Code § 27-1-37.5-24 Emergency admission or provision of emergency health care services
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Sec. 24. (a) A utilization review entity shall allow a covered individual and a covered individual's health care provider at least twenty-four (24) hours (excluding weekends and state and federal legal holidays) after an emergency admission or provision of emergency health care s…