{"data":{"id":"us-in/ic-27-8-16-9.5","jurisdiction":"us-in","citation":"IC 27-8-16-9.5","heading":"Claim determinations based on data base information","body":"Sec. 9.5. (a) As used in this section, \"data base\" means a data base that provides information concerning health care services or amounts charged for health care services.\n(b) If a claim review agent bases a medical claims review determination concerning a health care service provided by a hospital licensed under IC 12-25 or IC 16-21 in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21.\n(c) If a claim review consultant makes a recommendation or provides consultation concerning the appropriateness of or the amount charged for services provided by a hospital licensed under IC 12-25 or IC 16-21 based in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21.\n(d) This section does not apply to:\n(1) medical claims review determinations made under subsection (b); or\n(2) consultations or recommendations made under subsection (c);\nregarding medical services provided under IC 22.","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#27-8-16-9.5","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"f74bff4520a7c3c0f068963210eab01253f5fa0d6243b6384a92092046591134","source_id":"us-in","stale":false,"prev":"us-in/ic-27-8-16-9","next":"us-in/ic-27-8-16-10"},"notice":"GroundRules: Original legal text. Not legal advice."}