Ind. Code ch. 12-15-11.5

Ind. Code ch. 12-15-11.5
in effect

Ind. Code § 12-15-11.5-0.5 Nonapplicability to certain managed care organizations

Sec. 0.5. This chapter does not apply to a managed care organization that, on or before July 1, 2000, did not directly contract with a hospital (as defined in section 1 of this chapter) for the provision of services under the office's managed care program. As added by P.L.141-2001, SEC.1. Amended by P.L.152-2017, SEC.7.

Ind. Code § 12-15-11.5-1 "Hospital"

Sec. 1. As used in this chapter, "hospital" refers to an acute care hospital provider that: (1) is licensed under IC 16-21; (2) qualifies as a disproportionate share hospital under IC 12-15-16; and (3) is the sole disproportionate share hospital in a city located in a county having a population of more than four hundred thousand (400,000) and less than seven hundred thousand (700,000). As added by P.L.142-2000, SEC.2. Amended by P.L.11-2023, SEC.42.

Ind. Code § 12-15-11.5-2 Hospital as contracted provider to eligible individuals

Sec. 2. The office's managed care organization shall regard a hospital as a contracted provider in the office's managed care program, which provides a capitated prepayment managed care system, for the provision of medical services to each individual who: (1) is eligible to receive services under IC 12-15 and has enrolled in the office's managed care services program; (2) resides in the same city in which the hospital is located; and (3) has selected a primary care provider who: (A) is a contracted provider with the office's managed care organization; and (B) has medical staff privileges at the hospital. As added by P.L.142-2000, SEC.2. Amended by P.L.141-2001, SEC.2; P.L.152-2017, SEC.8.

Ind. Code § 12-15-11.5-3 Repealed

As added by P.L.142-2000, SEC.2. Amended by P.L.141-2001, SEC.3; P.L.122-2002, SEC.1. Repealed by P.L.145-2005, SEC.30.

Ind. Code § 12-15-11.5-6 Claim for reimbursement treated as disputed claim

Sec. 6. A claim for reimbursement for services shall be treated as a disputed claim under this chapter if: (1) it is submitted within one hundred twenty (120) days after the date that services are rendered; (2) it is denied by the managed care organization; (3) the hospital submits a written notice of dispute for the claim to the managed care organization not more than sixty (60) days after the receipt of the denial notice; (4) it is appealed in accordance with the managed care organization's internal appeals process; and (5) payment for the claim is denied by the managed care organization following its internal appeals process. As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.9.

Ind. Code § 12-15-11.5-7 Conclusion of appeal

Sec. 7. The office's managed care organization must conclude an appeal under section 6(4) of this chapter and notify the hospital of its decision not more than thirty-five (35) days after the managed care organization receives a notice from the hospital disputing the managed care organization's denial of a claim. As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.10.

Ind. Code § 12-15-11.5-8 Dispute resolution procedure requirements

Sec. 8. (a) A contract entered into by a hospital with the office's managed care organization for the provision of services under the office's managed care program must include a dispute resolution procedure for all disputed claims. Unless agreed to in writing by the hospital and the office's managed care organization, the dispute resolution procedure must include the following requirements: (1) That submission of disputed claims must be made to an independent arbitrator selected under subsection (b). (2) Each claim must set forth with specificity the issues to be arbitrated, the amount involved, and the relief sought. (3) That the hospital and the office's managed care organization shall attempt in good faith to resolve all disputed claims. (4) The hospital shall submit to the arbitrator any claims that remain in dispute sixty (60) calendar days after the hospital receives written notice as provided under section 7 of this chapter. (5) That resolution of disputes by the arbitrator must occur not later than ninety (90) calendar days after submission of disputed claims to the arbitrator, unless the parties mutually agree otherwise. (6) That determinations of the arbitrator are final and binding and not subject to any appeal or review procedure. (7) That the arbitrator does not have the authority to award any punitive or exemplary damages or to vary or ignore the terms of any contract between the parties and shall be bound by controlling law. (8) That judgment upon the award rendered by the arbitrator may be entered and enforced in and is subject to the jurisdiction of a court with jurisdiction in Indiana. (9) That the cost of the arbitrator must be shared equally by the parties, and each party must bear its own attorney and witness fees. (b) The parties to a contract described in subsection (a) shall mutually agree on an independent arbitrator, or, if the parties are unable to reach agreement on an independent arbitrator, the following procedure must be followed: (1) Each party shall select an independent representative, and the independent representatives shall select a panel of three (3) independent arbitrators who have experience in institutional and professional health care delivery practices and procedures and have had no prior dealing with either party other than as an arbitrator. (2) The parties will each strike one (1) arbitrator from the panel selected under subdivision (1), and the remaining arbitrator serves as the arbitrator of the disputed claims under subsection (a). (3) The procedures for selecting an arbitrator under this section must be completed not later than twenty (20) calendar days after the hospital provides written notice of at least one (1) disputed claim. As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.11.

Ind. Code § 12-15-11.5-9 Arbitration process for dispute resolution between hospital and managed care organization

Sec. 9. The arbitration process described in section 8 of this chapter shall also be followed for resolution of disputed claims between a hospital and the office's managed care organization, if the hospital is not a contracted provider in the office's managed health care program. As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.12.

Ind. Code § 12-15-11.5-10 Arbitration of disputed claims

Sec. 10. A hospital and the managed care organization of the office shall use the arbitration procedure in section 8 of this chapter for the resolution of all disputed claims that have accrued as of March 17, 2000. As added by P.L.220-2011, SEC.265. Amended by P.L.152-2017, SEC.13.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026