Ind. Code § 27-8-16-9.5

Claim determinations based on data base information

As added by P.L.260-1995, SEC.7.
  1. (a) As used in this section, "data base" means a data base that provides information concerning health care services or amounts charged for health care services.
  2. (b) If a claim review agent bases a medical claims review determination concerning a health care service provided by a hospital licensed under IC 12-25 or IC 16-21 in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21 .
  3. (c) If a claim review consultant makes a recommendation or provides consultation concerning the appropriateness of or the amount charged for services provided by a hospital licensed under IC 12-25 or IC 16-21 based in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21 .
  4. (d) This section does not apply to:

    1. (1) medical claims review determinations made under subsection (b); or
    2. (2) consultations or recommendations made under subsection (c);

      regarding medical services provided under IC 22 .

As added by P.L.260-1995, SEC.7.

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