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Indiana · Snapshot 2026

IC 27-1-37.5-1.7: "Clinical peer"

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Where this section sits in the code
  1. TITLE 27. INSURANCE
  2. ARTICLE 1. DEPARTMENT OF INSURANCE
  3. Chapter 37.5. Health Care Service Prior Authorization

Sec. 1.7. As used in this chapter, "clinical peer" means the following:

(1) Except as provided in subdivision (3), for a review of a request from a physician, a physician who:

(A) holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered;

(B) is certified in the same specialty as the physician under review, as recognized by:

(i) the American Board of Medical Specialties; or

(ii) the American Osteopathic Association; and

(C) if the review specifically concerns subspecialty care, is certified in the same subspecialty as the physician under review, as recognized by:

(i) the American Board of Medical Specialties; or

(ii) the American Osteopathic Association.

(2) For a review of a request from an advanced practice registered nurse, an advanced practice registered nurse who:

(A) holds a current and valid license under IC 25-23-1 or has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered; and

(B) holds equivalent or similar:

(i) population focus; and

(ii) role specialty;

as the advanced practice registered nurse who is subject to the review.

(3) For a review of a request from a primary care physician (as defined in IC 25-22.5-5.5-1.5), a physician who:

(A) holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered;

(B) is certified in the same general practice of medicine under review, as recognized by:

(i) the American Board of Medical Specialties;

(ii) the American Board of Pediatrics; or

(iii) the American Osteopathic Association; and

(C) has been actively engaged in general practice for at least three (3) years.

(4) For a review of a request from a practitioner or health care provider other than those specified in subdivisions (1) through (3), a practitioner or health care provider who:

(A) holds a current and valid license in Indiana;

(B) has been granted reciprocity in Indiana, if reciprocity exists; or

(C) holds a license that is part of a compact in which Indiana has entered.

Collected 2026-09-25T05:39:04Z. Source file · JSON

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