405 IAC 5-30-4
405 IAC 5-30-4 Prior authorization
Cite as Ind. Admin. Code tit. 405, r. 5-30-4
Sec. 4. Prior authorization is required for the following transportation services:
(1) Train or bus services.
(2) Family member services.
(3) Airline or air ambulance and transportation services rendered by a provider located out of state in a nondesignated
area.
(4) Transportation rendered by a provider to or from an out-of-state nondesignated area.
(5) Trips exceeding twenty (20) one-way trips for each member each calendar year, except as specified in section 1 of this
rule.
(6) One-way trips of fifty (50) miles or more.