HB 1374

  • Indiana House Bill
  • 2021 Regular Session
  • Introduced in House
  • House
  • Senate
  • Governor

Medicaid providers and managed care organizations.


Allows a provider that has entered into a contract with a managed care organization, after exhausting any internal procedures of the managed care organization for provider grievances and appeals, to request an administrative appeal within the office of Medicaid policy and planning of the managed care organization's action in denying or reducing reimbursement for claims for covered services provided to an applicant, pending applicant, conditionally eligible individual, or member. Establishes a procedure for an administrative appeal, including a hearing before an administrative law judge that could be followed by agency review and then by judicial review. Prohibits a provision in a contract between a provider and a managed care organization that would negate or restrict the right of a provider to an administrative appeal and provides that such a contract provision is void and unenforceable. Repeals a provision under which Medicaid law is controlling when Medicaid law conflicts with insurance law. Provides that if the office of the secretary of family and social services or a contractor of the office fails to pay or denies a clean claim for any eligible Medicaid service within certain time limits due to the office or contractor incorrectly processing the clean claim because of errors attributable to the internal system of an insurer or managed care organization, the office or contractor may not assert that the provider failed to meet the time filing requirements for the claim.

Bill Sponsors (4)


No votes to display


Jan 14, 2021


Coauthored by Representatives Vermilion, Thompson, Fleming


Authored by Representative Clere


First reading: referred to Committee on Public Health

  • Reading-1
  • Referral-Committee
public health

Bill Text

Bill Text Versions Format
Introduced House Bill (H) PDF

Related Documents

Document Format
Fiscal Note: HB1374.01.INTR.FN001 PDF


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