Ind. Code § 27-1-52-11
This is the official text of Ind. Code § 27-1-52-11, 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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Notice requirement
Official statutory text
Sec. 11. If a claim is downcoded, the insurer shall:
(1) notify the provider using the appropriate CARC and RARC to clearly indicate that the claim has been downcoded; and
(2) provide:
(A) the specific reason for the downcoding, including reference to the clinical criteria used to justify the downcoding;
(B) the original and revised service codes and payment amounts; and
(C) a notice of the right to appeal as described in section 12 of this chapter.
As added by P.L.88-2026, SEC.6.
(1) notify the provider using the appropriate CARC and RARC to clearly indicate that the claim has been downcoded; and
(2) provide:
(A) the specific reason for the downcoding, including reference to the clinical criteria used to justify the downcoding;
(B) the original and revised service codes and payment amounts; and
(C) a notice of the right to appeal as described in section 12 of this chapter.
As added by P.L.88-2026, SEC.6.
Status: in_force · Read it on the official government site
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