IC 12-15-44.1
    Chapter 44.1. Coordination of Benefits Study

IC 12-15-44.1-1
"Covered entity"
    Sec. 1. As used in this chapter, "covered entity" has the meaningset forth in 45 CFR 160.103.
As added by P.L.3-2008, SEC.97.

IC 12-15-44.1-2
Analysis of claims
    Sec. 2. (a) Before January 1, 2008, the office shall do thefollowing:
        (1) Examine all Medicaid claims paid after January 1, 2001, andbefore July 1, 2007.
        (2) Determine the claims examined under subdivision (1) thatwere eligible for payment by a third party other than Medicaid.
        (3) Recover the costs associated with the claims determinedunder subdivision (2) to be eligible for payment by a third partyother than Medicaid.
    (b) If the office requests a covered entity to furnish informationto complete the examination required by this section, the coveredentity shall furnish the requested information to the office.
As added by P.L.3-2008, SEC.97.

IC 12-15-44.1-3
Release of human identifier information; determination ofeligibility
    Sec. 3. (a) The office is authorized to transmit the minimumhuman identifiers in ANSI X.12 270 inquiries, including the name,gender, and date of birth of a Medicaid recipient, to a covered entitylicensed or registered to provide health insurance or health carecoverage to Indiana residents for the purpose of establishing thecoverage in force of a Medicaid recipient who presents a claim.
    (b) A health plan that receives a message described in subsection(a) from the office or its agent shall respond to the office or its agentwithin twenty-four (24) hours.
    (c) An entity licensed or registered to provide health insurance orhealth care coverage to Indiana residents that refuses an ANSI X.12270 message described in subsection (a) that was transmitted to theentity by the office or its agent is subject to a fine for each refusal inan amount not to exceed one thousand dollars ($1,000) for eachrefusal.
    (d) The office may impose the fine described in subsection (c).
As added by P.L.3-2008, SEC.97.

IC 12-15-44.1-4
Enforcement; injunctive relief; costs
    Sec. 4. The office, any medical provider wishing to bill IndianaMedicaid, or any health plan has a cause of action for injunctive

relief against any health plan that fails to comply with this chapter.A plaintiff seeking relief under this section may recover costs oflitigation, including attorney's fees.
As added by P.L.3-2008, SEC.97.

IC 12-15-44.1-5
Enforcement; attorney general
    Sec. 5. If the office or its agent furnishes evidence that a healthplan has refused or failed to respond to messages described in section3(a) of this chapter transmitted by the office or its agent to the healthplan, the attorney general shall:
        (1) subpoena the enrollment data of any entity that refuses orfails to respond to the messaging described in section 3(a) ofthis chapter;
        (2) commence a complaint under 42 U.S.C. 1320d-5 foradministrative sanctions under the Health Insurance Portabilityand Accountability Act of 1996 (P.L. 104-191); and
        (3) commence a prosecution under U.S.C. 1035 or IC 5-11-5.5of any entity that refuses or fails to respond to the messagingdescribed under section 3(a) of this chapter.
As added by P.L.3-2008, SEC.97.

IC 12-15-44.1-6
Implementation of procedures to coordinate benefit payments
    Sec. 6. (a) If, after the office completes its examination undersection 2 of this chapter, the office determines that the number ofclaims determined under section 2(a)(2) of this chapter is at least onepercent (1%) of the number of claims examined under section 2(a)(1)of this chapter, the office shall develop and implement a procedureto improve the coordination of benefits between:
        (1) the Medicaid program; and
        (2) entities that provide health coverage to a Medicaid recipient.
    (b) If a procedure is developed and implemented under subsection(a), the procedure:
        (1) must be automated; and
        (2) must have the capability to determine whether a Medicaidclaim is eligible for payment by an entity other than theMedicaid program before the claim is paid under the Medicaidprogram.
As added by P.L.3-2008, SEC.97.