{"data":{"id":"us-in/ic-27-1-37.5-1.7","jurisdiction":"us-in","citation":"IC 27-1-37.5-1.7","heading":"\"Clinical peer\"","body":"Sec. 1.7. As used in this chapter, \"clinical peer\" means the following:\n(1) Except as provided in subdivision (3), for a review of a request from a physician, a physician who:\n(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;\n(B) is certified in the same specialty as the physician under review, as recognized by:\n(i) the American Board of Medical Specialties; or\n(ii) the American Osteopathic Association; and\n(C) if the review specifically concerns subspecialty care, is certified in the same subspecialty as the physician under review, as recognized by:\n(i) the American Board of Medical Specialties; or\n(ii) the American Osteopathic Association.\n(2) For a review of a request from an advanced practice registered nurse, an advanced practice registered nurse who:\n(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\n(B) holds equivalent or similar:\n(i) population focus; and\n(ii) role specialty;\nas the advanced practice registered nurse who is subject to the review.\n(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:\n(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;\n(B) is certified in the same general practice of medicine under review, as recognized by:\n(i) the American Board of Medical Specialties;\n(ii) the American Board of Pediatrics; or\n(iii) the American Osteopathic Association; and\n(C) has been actively engaged in general practice for at least three (3) years.\n(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:\n(A) holds a current and valid license in Indiana;\n(B) has been granted reciprocity in Indiana, if reciprocity exists; or\n(C) holds a license that is part of a compact in which Indiana has entered.","path":["TITLE 27. INSURANCE","ARTICLE 1. DEPARTMENT OF INSURANCE","Chapter 37.5. Health Care Service Prior Authorization"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-1-37.5-1.7","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"c549f44599d918fcddd79856daa3983a9b9a2a3f07f70d6e0eb9b1554211852e","source_id":"us-in","stale":false,"prev":"us-in/ic-27-1-37.5-1.6","next":"us-in/ic-27-1-37.5-1.8"},"notice":"GroundRules: Original legal text. Not legal advice."}