IC 27-1-37.5-27: Utilization review entity's duty to honor certain authorizations

Sec. 27. (a) A utilization review entity shall honor an authorization that was granted to a covered individual by a previous utilization review entity for at least the initial ninety (90) days of the covered individual's coverage under a new health plan if:

(1) the utilization review entity receives information documenting the authorization from the covered individual or the covered individual's health care provider; and

(2) the authorization is for a health care service that is covered under the new health plan.

(b) During the time period described in subsection (a), a utilization review entity may perform its own review of the prior authorization request.

(c) If there is a change in:

(1) coverage of; or

(2) approval criteria for;

a previously authorized health care service, the change in coverage or approval criteria may not affect a covered individual who received authorization before the effective date of the change for the remainder of the plan year.

(d) A utilization review entity shall continue to honor an authorization that the utilization review entity granted to a covered individual when the covered individual changes products under the same health insurance company.