Ind. Code § 27-1-37.5-13
This is the official text of Ind. Code § 27-1-37.5-13, part of Indiana’s Code — part of the compiled statutory law of Indiana, published by the state as "Code." Browse the sections below, each linked to its official government source.
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Unanticipated, medically necessary health care service
Official statutory text
Sec. 13. (a) This section applies to a claim filed after June 30, 2025, for a medically necessary health care service rendered by a health care provider, the necessity of which:
(1) is not anticipated at the time of scheduling another health care service that:
(A) was authorized by the utilization review entity; or
(B) is not subject to a prior authorization requirement; and
(2) is determined at the time the other health care service is rendered.
(b) A utilization review entity may not:
(1) require retrospective review of; or
(2) deny a claim based solely on lack of prior authorization for;
an unanticipated health care service described in subsection (a).
(c) A health care provider that renders an unanticipated health care service described in subsection (a) shall submit to the utilization review entity documentation explaining why the unanticipated health care service was medically necessary.
As added by P.L.77-2018, SEC.2. Amended by P.L.144-2025, SEC.22.
(1) is not anticipated at the time of scheduling another health care service that:
(A) was authorized by the utilization review entity; or
(B) is not subject to a prior authorization requirement; and
(2) is determined at the time the other health care service is rendered.
(b) A utilization review entity may not:
(1) require retrospective review of; or
(2) deny a claim based solely on lack of prior authorization for;
an unanticipated health care service described in subsection (a).
(c) A health care provider that renders an unanticipated health care service described in subsection (a) shall submit to the utilization review entity documentation explaining why the unanticipated health care service was medically necessary.
As added by P.L.77-2018, SEC.2. Amended by P.L.144-2025, SEC.22.
Status: in_force · Read it on the official government site
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