Prohibited Bases for Compensation of Claim Review Agents and Consultants

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Sec. 11. (a) The compensation of a claim review agent for the performance of medical claims review may not be based on the amount by which claims are reduced for payment.

(b) The compensation of a claim review consultant for making a recommendation or providing consultation concerning the appropriateness of or amount charged for a health care service delivered to an enrollee in Indiana may not be based on the amount by which a claim relating to the service is reduced for payment.

As added by P.L.128-1992, SEC.2. Amended by P.L.260-1995, SEC.8.


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