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Ind. Code § 27-13-43-5

Provisional credentialing for physicians; conditions

As added by P.L.215-2025, SEC.66.

Sec. 5. (a) As used in this section, "physician" refers to an individual who:

(1) is licensed under IC 25-22.5;

(2) has been granted reciprocity by the medical licensing board of Indiana under IC 25-1-21 before July 1, 2026; or

(3) is licensed in a state that has enacted the interstate medical licensure compact.

(b) If a physician who is fully credentialed by a health maintenance organization:

(1) leaves the employment of an employer and becomes employed with another employer in Indiana; or

(2) establishes or relocates a medical practice in Indiana;

the health maintenance organization shall provisionally credential the physician for the time frame set forth in subsection (c).

(c) A physician under subsection (b) must be provisionally credentialed:

(1) for sixty (60) days after the physician's separation from employment or the establishment or relocation of the medical practice; or

(2) until the physician is fully credentialed by the health maintenance organization;

whichever is earlier.

(d) Notwithstanding section 2(j) of this chapter, a health maintenance organization shall reimburse a physician who is provisionally credentialed under this section for services rendered while the physician was provisionally credentialed at the rates determined by:

(1) the agreement between the physician's new employer and the health maintenance organization relating to terms and conditions of reimbursement; or

(2) if:

(A) the physician's new employer has not entered into an agreement with the health maintenance organization relating to the terms and conditions of reimbursement; or

(B) the physician established or relocated a medical practice;

the agreement between the physician and the health maintenance organization relating to terms and conditions of reimbursement that was in effect at the time of the physician's separation from employment or the establishment or relocation of the medical practice.

Official source: Indiana General Assembly. Reproduced from public-domain Indiana statutes; confirm against the official source for the current text. Not legal advice.