Indiana hospitals share payment help and insurers explain claim cuts

Hospitals give patients written information about payment help. Hospitals give notice to patients or their representatives. A collection action includes referring or selling a bill to a collection agency or suing over medical debt; it can be taken by a hospital or an organization with a financial relationship with it. The notice includes available programs, eligibility rules, application instructions, and contact information for help applying. Before starting a collection action, a hospital makes a reasonable effort to give the person notice and an application form. Hospitals give written notice at one of three times: during registration or intake, at discharge, or with the first bill. They post signs in registration areas and emergency departments and share information through any patient portal they maintain.

Insurers explain reduced claim payments and provide a way for providers to appeal. The rules cover listed health insurers, health maintenance organizations, and their contractors when handling provider claims for people covered by a health plan. These rules do not apply to Medicaid or managed care organizations serving Medicaid recipients. An insurer cannot base a medical-necessity reduction solely on an automated tool without a person reviewing the patient's medical record, or base a reduction solely on the diagnosis code. Insurers disclose when they use artificial intelligence to reduce a claim or make an adverse decision on a prior authorization request. The appeal deadline must be at least 180 days. This chapter takes effect July 1, 2026.

Insurers and health maintenance organizations follow limits on rate cuts and claim recoveries. These provisions cover insurers and health maintenance organizations paying providers under the specified insurance policies and health plan contracts. They cannot retroactively reduce reimbursement rates for CPT codes, and must give providers at least 60 days' notice before a prospective rate reduction. They cannot seek repayment of an overpayment or recoup a paid claim more than 180 days after payment, or retroactively audit a paid claim more than three years after payment. The limits on repayment requests, recoupment, and correction of payment errors do not apply when a court makes a final fraud determination. Insurers and hospitals may make a written agreement for different time limits. The rate and claim rules take effect July 1, 2026. The 180-day recovery limits and three-year audit limit run from the date of payment.

Providers may submit certain claims to the appropriate plan after a payment is taken back. This applies when a provider's payment is taken back due to an error coordinating benefits between an insurer and a health maintenance organization. The insurer or health maintenance organization must have taken back payment because benefits were coordinated incorrectly. The provider supplies documents showing the original claim and the payment recovery. The receiving plan may allow more time. The provider has 90 days from the payment recovery to submit the claim, unless the receiving plan allows more time.