Ind. Code § 27-1-37.5-13
Unanticipated, medically necessary health care service
Indiana · Indiana Code Title 27 — Insurance · Status: effective
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- Citation
- Ind. Code § 27-1-37.5-13, Unanticipated, medically necessary health care service, Indiana, version 1 as recorded 2026-09-28, yourstate.us, https://yourstate.us/provision/1662496
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Full text
Sec. 13.
(a) This section applies to a claim filed after June 30, 2025, for a medically necessary health care service rendered by a health care provider, the necessity of which:
(1) is not anticipated at the time of scheduling another health care service that:
(A) was authorized by the utilization review entity; or
(B) is not subject to a prior authorization requirement; and
(2) is determined at the time the other health care service is rendered.
(b) A utilization review entity may not:
(1) require retrospective review of; or
(2) deny a claim based solely on lack of prior authorization for;
an unanticipated health care service described in subsection (a).
(c) A health care provider that renders an unanticipated health care service described in subsection (a) shall submit to the utilization review entity documentation explaining why the unanticipated health care service was medically necessary.