Indiana prior authorization laws (2026)

General reference compiled from public statutes and the AMA state-law chart. This is not legal advice. Statutes change; confirm the current law before relying on it.

Decision deadlines

Prior authorization (State-regulated health plans)
Standard decision: 5 business_days. Expedited: 48 hours.
Indiana SB 400 (2023) · source

Gold-card law

Providers with a strong approval history may be exempted from prior authorization for qualifying services, with an approval threshold around 85% (12 months). Prescription drugs are included. Confirm current eligibility with the payer.
Indiana HB 1091 · source

Patient-protection mandates

Retrospective Denial Prohibition
A plan cannot deny claims for lack of PA for unanticipated services provided during an already-authorized service.
Indiana SB 400 (2023) · source

Frequently asked questions

How long does an insurer have to decide a prior authorization in Indiana?

Under Indiana SB 400 (2023), a standard prior authorization decision is generally due within 5 business_days, and an expedited decision within 48 hours. Confirm the current statute, as timeframes vary by plan type.

Does Indiana have a gold-card prior authorization law?

Yes. Indiana has a gold-card law (Indiana HB 1091) that can exempt providers with a strong approval history from prior authorization for qualifying services. Confirm current eligibility thresholds with the payer.

What prior authorization patient protections does Indiana have?

Indiana law includes retrospective denial prohibition. Each is grounded in a specific statute (see above).

Other states

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