{"data":{"id":"us-in/ic-27-1-52-11","jurisdiction":"us-in","citation":"IC 27-1-52-11","heading":"Notice requirement","body":"Sec. 11. If a claim is downcoded, the insurer shall:\n(1) notify the provider using the appropriate CARC and RARC to clearly indicate that the claim has been downcoded; and\n(2) provide:\n(A) the specific reason for the downcoding, including reference to the clinical criteria used to justify the downcoding;\n(B) the original and revised service codes and payment amounts; and\n(C) a notice of the right to appeal as described in section 12 of this chapter.","path":["TITLE 27. INSURANCE","ARTICLE 1. DEPARTMENT OF INSURANCE","Chapter 52. Downcoding of Health Benefits Claims"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-1-52-11","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"3811d0d546ecb62906db46852d854a031248e5e7827662f3d65fd29880127f13","source_id":"us-in","stale":false,"prev":"us-in/ic-27-1-52-10","next":"us-in/ic-27-1-52-12"},"notice":"GroundRules: Original legal text. Not legal advice."}