Required disclosures

Sec. 7.5. (a) This section applies to a health provider contract entered into, amended, or renewed after June 30, 2025. (b) When a health carrier is in the process of negotiating a health provider contract with a health provider facility or provider, the health carrier must provide to the health provider facility or provider the following: (1) A current fee schedule that must include the following information: (A) The proposed reimbursement for each covered service under the proposed health provider contract. (B) The twenty-fifth percentile, fiftieth percentile, and seventy-fifth percentile reimbursement amounts in Indiana for each covered service under the proposed health provider contract. (2) The current criteria that the health carrier uses when determining whether to issue an administrative denial. (c) When a health provider facility or provider is in the process of negotiating a health provider contract with a health carrier, the health provider facility or provider shall provide the health carrier with the twenty-fifth percentile, fiftieth percentile, and seventy-fifth percentile reimbursement amounts that the health provider facility or provider receives for each covered service under the proposed health provider contract.