CHAPTER 22.1. CLAIMS

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 insurancepolicy" means an insurance policy that provides at least one (1) ofthe 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 theworker's compensation board to carry the employer's worker'scompensation 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 setforth 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 dateof 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 andStatistical 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 providedunder an accident and sickness insurance policy or a worker'scompensation 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 andStatistical 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 forservices provided under an accident and sickness insurancepolicy or a worker's compensation policy.
    (b) If a provider provides services that are covered under anaccident and sickness insurance policy or a worker's compensationpolicy:
        (1) after the effective date of the most current version of adiagnostic or procedure code described in subsection (a); and
        (2) before the insurer begins using the most current version ofthe diagnostic or procedure code;
the insurer shall reimburse the provider under the version of thediagnostic or procedure code that was in effect on the date that theservices were provided.
As added by P.L.161-2001, SEC.4. Amended by P.L.66-2002,SEC.16.