Medical Claims Review Agent Initial Registration
Initial registration for a new Medical Claims Review Agent can be completed electronically at www.sircon.com/Indiana or submitted by paper. The following items must be submitted in order to register as a Medical Claims Review Agent.
- Application - Each question must be completed in full. If additional space is needed, attach a separate sheet of paper, properly signed.
- $150 Application Fee
- Medical Claims Review Checklist- Complete the “Located” column on the checklist with the section and page number of your submission indicating where the item can be found. Attach supporting documentation.
URAC accreditation does not waive any requirement for documentation submission.
If registering by paper, the completed application, application fee and supporting documentation should be sent to the following address:
Indiana Department of Insurance
Attn: Medical Claims Review
311 West Washington Street, Ste 300
Indianapolis, Indiana 46204
For any questions, contact Rebecca Vaughan at (317) 232-2187 or firstname.lastname@example.org