- (a) This section applies to a health provider contract entered into, amended, or renewed after June 30, 2025.
(b) When a health carrier is in the process of negotiating a health provider contract with a health provider facility or provider, the health carrier must provide to the health provider facility or provider the following:
(1) A current fee schedule that must include the following information:
- (A) The proposed reimbursement for each covered service under the proposed health provider contract.
- (B) The twenty-fifth percentile, fiftieth percentile, and seventy-fifth percentile reimbursement amounts in Indiana for each covered service under the proposed health provider contract.
- (2) The current criteria that the health carrier uses when determining whether to issue an administrative denial.
- (c) When a health provider facility or provider is in the process of negotiating a health provider contract with a health carrier, the health provider facility or provider shall provide the health carrier with the twenty-fifth percentile, fiftieth percentile, and seventy-fifth percentile reimbursement amounts that the health provider facility or provider receives for each covered service under the proposed health provider contract.
As added by P.L.215-2025, SEC.49.