Section 405IAC10-7-12. Prior authorization

   (a) An insurer may implement utilization control procedures, including prior authorization or precertification of services as provided under 42 CFR 438.210. The following services shall be exempt from prior authorization:

(1) Emergency services, subject to the requirements of section 9 of this rule.

(2) Family planning services.

(3) Urgent care.

  (b) A provider that:

(1) has an agreement with the office; and

(2) renders services to a member;

shall follow the utilization control procedures implemented by the member's insurer under subsection (a) regardless of whether that provider has a contract with the member's insurer.

  (c) Insurers shall make decisions regarding prior authorization and precertification in accordance with the requirements of 405 IAC 5-3-14. (Office of the Secretary of Family and Social Services; 405 IAC 10-7-12; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA)