Sec. 1. (a) This chapter applies to a referral made after December 31, 2017. (b) This chapter does not apply to the following: (1) A referral for treatment of an emergency medical condition. (2) A referral made: (A) immediately following treatment of an emergency medical condition; and (B) by the provider that rendered the treatment […]
Sec. 10. As used in this chapter, “provider group” means a legal entity: (1) that is owned by or employs one (1) or more providers; and (2) through which billing is performed for health care items and services rendered by the providers. As added by P.L.147-2017, SEC.1.
Sec. 11. (a) As used in this chapter, “referral” means a recommendation or direction made by a provider to a covered individual that the covered individual receive a health care item or service rendered by another provider that is not affiliated with the first provider. (b) The term does not include a recommendation or direction […]
Sec. 12. (a) This section does not apply to a referral made by a provider that has confirmed that the provider to which a covered individual is referred is a network provider with respect to the covered individual’s health plan. (b) A provider that makes a referral shall provide to the covered individual an electronic […]
Sec. 2. As used in this chapter, “affiliated” refers to a provider that is a member of the same provider group as another provider. As added by P.L.147-2017, SEC.1.
Sec. 3. As used in this chapter, “covered individual” means an individual who is entitled to coverage under a health plan. As added by P.L.147-2017, SEC.1.
Sec. 4. As used in this chapter, “emergency medical condition” means a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent lay person who possesses an average knowledge of health and […]
Sec. 5. (a) As used in this chapter, “health plan” means: (1) a policy of accident and sickness insurance (as defined in IC 27-8-5-1); (2) an individual contract or a group contract with a health maintenance organization under IC 27-13; or (3) another plan or program that provides payment, reimbursement, or indemnification for the costs […]
Sec. 6. As used in this chapter, “network” means a group of two (2) or more providers that have entered into: (1) an agreement with an insurer under IC 27-8-11-3; (2) a participating provider contract with a health maintenance organization under IC 27-13; or (3) an agreement with another person specifying terms and conditions of […]
Sec. 7. As used in this chapter, “network provider” means a provider described in section 6 of this chapter. As added by P.L.147-2017, SEC.1.
Sec. 8. As used in this chapter, “out of network provider” means a provider that is not described in section 6 of this chapter. As added by P.L.147-2017, SEC.1.
Sec. 9. (a) As used in this chapter, “provider” means a practitioner described in IC 25-1-9-2(a)(1). (b) The term does not include an individual who holds a license, certification, registration, or permit issued under the following: (1) IC 25-19. (2) IC 25-38.1. (c) The term includes a provider group. As added by P.L.147-2017, SEC.1. Amended […]
