Ind. Code § 27-1-48-1 "Covered individual"
Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a health plan.
As added by P.L.190-2023, SEC.24.
Ind. Code ch. 27-1-48
Ind. Code ch. 27-1-48
in effectInd. Code § 27-1-48-2 "CPT code"
Sec. 2. As used in this chapter, "CPT code" refers to the medical billing code that applies to a specific health care service, as published in the Current Procedural Terminology code set maintained by the American Medical Association.
As added by P.L.190-2023, SEC.24.
Ind. Code § 27-1-48-3 "Health care service"
Sec. 3. (a) As used in this chapter, "health care service" means a health care related service or product rendered or sold by a health care provider within the scope of the health care provider's license or legal authorization, including hospital, medical, surgical, mental health, and substance abuse services or products.
(b) The term does not include the following:
(1) Dental services.
(2) Vision services.
(3) Long term rehabilitation treatment.
(4) Pharmaceutical services or products.
As added by P.L.190-2023, SEC.24.
Ind. Code § 27-1-48-4 "Health plan"
Sec. 4. (a) As used in this chapter, "health plan" means any of the following that provides coverage for health care services:
(1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(a).
(2) A contract with a health maintenance organization (as defined in IC 27-13-1-19) that provides coverage for basic health care services (as defined in IC 27-13-1-4).
(3) The Medicaid risk based managed care program under IC 12-15.
(b) The term includes a person that administers any of the following:
(1) A policy described in subsection (a)(1).
(2) A contract described in subsection (a)(2).
(3) Medicaid risk based managed care.
As added by P.L.190-2023, SEC.24.
Ind. Code § 27-1-48-5 "Participating provider"
Sec. 5. As used in this chapter, "participating provider" refers to the following:
(1) A health care provider that has entered into an agreement with an insurer under IC 27-8-11-3.
(2) A participating provider (as defined in IC 27-13-1-24).
As added by P.L.190-2023, SEC.24.
Ind. Code § 27-1-48-6 "Prior authorization"
Sec. 6. As used in this chapter, "prior authorization" means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care service is rendered. The term includes prospective or utilization review procedures conducted before a health care service is rendered.
As added by P.L.190-2023, SEC.24.
Ind. Code § 27-1-48-7 Alternative method for claims submission
Sec. 7. A health plan must:
(1) offer an alternative method for submission of a claim for when the health plan has technical difficulties with the health plan's claims submission system; and
(2) post notice of the alternative method for claims submission on the health plan's website.
As added by P.L.190-2023, SEC.24.
Ind. Code § 27-1-48-8 Information required to be posted on health plan's website
Sec. 8. (a) Not later than February 1 of each calendar year, a health plan must post on the health plan's website:
(1) the thirty (30) most frequently submitted CPT codes that were submitted by participating providers for prior authorization during the previous calendar year; and
(2) the percentage of the thirty (30) most frequently submitted CPT codes that were approved in the previous calendar year, disaggregated by CPT code.
(b) A health plan must maintain the information required under subsection (a) on the health plan's website, organized by year and on a single and easily accessible web page.
As added by P.L.190-2023, SEC.24.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026