{"data":{"id":"us-in/ic-27-8-16-8","jurisdiction":"us-in","citation":"IC 27-8-16-8","heading":"Appeals procedure; written description; minimum standards; notice of appeal procedure on limitation or reduction of benefits","body":"Sec. 8. (a) An insurance company, a health maintenance organization, or another benefit program providing payment, reimbursement, or indemnification for health care costs that contracts with a claim review agent for medical claims review services shall maintain and make available upon request a written description of the appeals procedure by which an enrollee may seek a review of a determination by the claim review agent.\n(b) The appeals procedure referred to in subsection (a) must meet the following requirements:\n(1) On appeal, the determination must be made by a provider who holds a license in the same discipline as the provider who rendered the service.\n(2) The adjudication of an appeal of a determination must be completed within thirty (30) days after:\n(A) the appeal is filed; and\n(B) all information necessary to complete the appeal is received.\n(c) If a medical review determination results in a limitation or reduction of benefits, a notice of the appeals procedure shall be provided by the claim review agent to the provider who rendered the health care services.","path":["TITLE 27. INSURANCE","ARTICLE 8. LIFE, ACCIDENT, AND HEALTH","Chapter 16. Medical Claims Review"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-8-16-8","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"694f8cb0cacefa63ac7ec37703fd4c94e0e7246cf0487295b5abacfafe3c772e","source_id":"us-in","stale":false,"prev":"us-in/ic-27-8-16-7","next":"us-in/ic-27-8-16-9"},"notice":"GroundRules: Original legal text. Not legal advice."}