Ind. Code § 27-1-37.5-19
This is the official text of Ind. Code § 27-1-37.5-19, 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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Publishing prior authorization requirements and restrictions and information about prior authorization approvals and denials; implementing new or amending current prior authorization requirements or restrictions; annual report
Official statutory text
Sec. 19. (a) A utilization review entity shall make any current prior authorization requirements and restrictions, including written clinical criteria, readily accessible on the utilization review entity's website to covered individuals, health care providers, and the general public. The prior authorization requirements and restrictions must be described in detail and in easily understandable language.
(b) A utilization review entity may not implement a new prior authorization requirement or restriction or amend an existing requirement or restriction unless:
(1) the utilization review entity's website has been updated to reflect the new or amended requirement or restriction; and
(2) the utilization review entity provides written notice to covered individuals and health care providers at least sixty (60) days before the requirement or restriction is implemented.
(c) A utilization review entity shall make statistics available regarding prior authorization approvals and denials on the utilization review entity's website in a readily accessible format, including statistics for the following categories:
(1) Health care provider specialty.
(2) Medication or diagnostic test or procedure.
(3) Indication offered.
(4) Reason for denial.
(5) If a decision was appealed.
(6) If a decision was approved or denied on appeal.
(7) The time between submission and the response.
(d) Not later than December 31 of each year, a utilization review entity shall:
(1) prepare a report of the statistics compiled under subsection (c); and
(2) submit the report to the department.
As added by P.L.144-2025, SEC.28.
(b) A utilization review entity may not implement a new prior authorization requirement or restriction or amend an existing requirement or restriction unless:
(1) the utilization review entity's website has been updated to reflect the new or amended requirement or restriction; and
(2) the utilization review entity provides written notice to covered individuals and health care providers at least sixty (60) days before the requirement or restriction is implemented.
(c) A utilization review entity shall make statistics available regarding prior authorization approvals and denials on the utilization review entity's website in a readily accessible format, including statistics for the following categories:
(1) Health care provider specialty.
(2) Medication or diagnostic test or procedure.
(3) Indication offered.
(4) Reason for denial.
(5) If a decision was appealed.
(6) If a decision was approved or denied on appeal.
(7) The time between submission and the response.
(d) Not later than December 31 of each year, a utilization review entity shall:
(1) prepare a report of the statistics compiled under subsection (c); and
(2) submit the report to the department.
As added by P.L.144-2025, SEC.28.
Status: in_force · Read it on the official government site
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