Section 27-1-37.5-12 - Claim for which prior authorization was given; denial; resubmission of claim(a) This section applies to a claim for a health care service rendered by a participating provider: (1) for which: (A) prior authorization is requested after December 31, 2019; and(B) a health plan gives prior authorization; and(2) that is rendered in accordance with: (A) the prior authorization; and(B) all terms and conditions of the participating provider's agreement or contract with the health plan.(b) The health plan shall not deny the claim described in subsection (a) unless: (1) the:(A) request for prior authorization; or(B) claim; contains fraudulent or materially incorrect information; or
(2) the covered individual is not covered under the health plan on the date on which the health care service is rendered.(c) If:(1) the claim described in subsection (a) contains an unintentional and inaccurate inconsistency with the request for prior authorization; and(2) the inconsistency results in denial of the claim; the health care provider may resubmit the claim with accurate, corrected information.
Added by P.L. 77-2018,SEC. 2, eff. 7/1/2018.