CHAPTER 22.1. CLAIMS - Indiana Statutes

IC 27-8-22.1
     Chapter 22.1. Claims

IC 27-8-22.1-1
"Accident and sickness insurance policy" defined
     Sec. 1. As used in this chapter, "accident and sickness insurance policy" means an insurance policy that provides at least one (1) of the types of insurance described in IC 27-1-5-1, Classes 1(b), 2(a), 2(b), 2(e), 2(f), and 2(h).
As added by P.L.161-2001, SEC.4.

IC 27-8-22.1-2
"Insurer" defined
     Sec. 2. As used in this chapter, "insurer" means:
        (1) an insurer that issues:
            (A) an accident and sickness insurance policy; or
            (B) a worker's compensation policy; or
        (2) an employer who has received a certificate from the worker's compensation board to carry the employer's worker's compensation risk without insurance under IC 22-3-2-5.
As added by P.L.161-2001, SEC.4.

IC 27-8-22.1-3
"Provider" defined
     Sec. 3. As used in this chapter, "provider" has the meaning set forth in IC 27-8-11-1.
As added by P.L.161-2001, SEC.4.

IC 27-8-22.1-4
"Worker's compensation policy" defined
     Sec. 4. As used in this chapter, "worker's compensation policy" means a policy of insurance issued to an employer under IC 22-3-2-5.
As added by P.L.161-2001, SEC.4.

IC 27-8-22.1-5
Use of diagnostic or procedure codes
     Sec. 5. (a) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
        (1) an insurer shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Healthcare common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the insurer pays claims for services provided under an accident and sickness insurance policy or a worker's compensation policy; and         (2) a provider shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Healthcare common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the provider submits claims for payment for services provided under an accident and sickness insurance policy or a worker's compensation policy.
    (b) If a provider provides services that are covered under an accident and sickness insurance policy or a worker's compensation policy:
        (1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (a); and
        (2) before the insurer begins using the most current version of the diagnostic or procedure code;
the insurer shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.
As added by P.L.161-2001, SEC.4. Amended by P.L.66-2002, SEC.16.