First Regular Session 115th General Assembly (2007)
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SENATE ENROLLED ACT No. 372
AN ACT concerning insurance.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: ; (07)SE0372.1.1. -->
SECTION 1. [EFFECTIVE JULY 1, 2007] (a) As used in this
SECTION, "department" refers to the department of insurance.
(b) As used in this SECTION, "insurer" means an insurer (as
defined in IC 27-1-2-3) that issues a policy of accident and sickness
(c) As used in this SECTION, "policy of accident and sickness
insurance" has the meaning set forth in IC 27-8-5-1. However, the
term does not include a policy described in IC 27-8-5-2.5(a).
(d) As used in this SECTION, "preauthorization" means a
(1) an insurer or an insurer's designated representative that
a proposed health care service is:
(A) eligible for coverage; and
(B) medically necessary; or
(2) a health maintenance organization that a proposed health
care service is:
(A) eligible for coverage; and
(B) medically necessary.
(e) The department shall study the current preauthorization
practices and procedures used by insurers and health maintenance
organizations. The department may also study standardization of
(1) Explanation of benefit forms.
(2) The length of time that a health care provider has to
submit a claim for payment for health care services to an
insurer or a health maintenance organization.
(3) The format, information, and location of information
concerning health benefit cards.
(4) The manner and time frame in which an out of network
health care provider is informed by an insurer or a health
maintenance organization of the reimbursement rate the
health care provider will receive for a CPT code of a health
care service for which the health care provider receives
preauthorization from the insurer or health maintenance
(f) In conducting the study, the department shall allow
representatives of insurers, health maintenance organizations, and
health care providers to provide testimony concerning whether the
practices and procedures described in subsection (e) require the
establishment of standards to ensure uniformity, timely response,
and the provision of reasonably sufficient information to health
care providers concerning payment of claims.
(g) Before November 1, 2007, the department shall report to the
legislative council in an electronic format under IC 5-14-6
concerning the department's findings resulting from the study
conducted under this SECTION. The report must include any
statutory recommendations that the department considers
necessary to address issues studied under this SECTION for which
the department does not have current authority to act.
(h) This SECTION expires December 31, 2008.
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