IN Code §27-1-37.5-12(a-b)

October 15, 2021 6:23 am | Published by

(a) This section applies to a claim for a health care service rendered by a participating provider:

(1) for which:

(A) prior authorization is requested after December 31, 2019; and

(B) a health plan gives prior authorization; and

(2) that is rendered in accordance with:

(A) the prior authorization; and

(B) all terms and conditions of the participating provider’s agreement or contract with the health plan.

(b) The health plan shall not deny the claim described in subsection (a) unless:

(1) the:

(A) request for prior authorization; or

(B) claim; contains fraudulent or materially incorrect information; or

(2) the covered individual is not covered under the health plan on the date on which the health care service is rendered.

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