{"data":{"id":"us-in/ic-27-8-17-6","jurisdiction":"us-in","citation":"IC 27-8-17-6","heading":"\"Utilization review\" defined","body":"Sec. 6. (a) As used in this chapter, \"utilization review\" means a system for prospective, concurrent, or retrospective review of the medical necessity and appropriateness of health care services provided or proposed to be provided to a covered individual.\n(b) The term does not include the following:\n(1) Elective requests for clarification of coverage, eligibility, or benefits verification.\n(2) Medical claims review (as defined in IC 27-8-16-4).","path":["TITLE 27. INSURANCE","ARTICLE 8. LIFE, ACCIDENT, AND HEALTH","Chapter 17. Health Care Utilization Review"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-8-17-6","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"9f038cfebbfc41158853e0dfb306146bda760953ed7cd63db94df83ef8adffc2","source_id":"us-in","stale":false,"prev":"us-in/ic-27-8-17-5","next":"us-in/ic-27-8-17-7"},"notice":"GroundRules: Original legal text. Not legal advice."}