Sec. 0.5. (a) Except as provided in section 0.6 of this chapter, as used in this chapter, "clean claim" means a claim submitted by a provider for payment under the Medicaid program that can be processed without obtaining additional information from:
(1) the provider of the service; or
(2) a third party.
(b) The definition under subsection (a):
(1) includes a claim with errors originating in the state's claims processing system; and
(2) does not include a claim:
(A) from a provider who is under investigation for fraud or abuse (as used in 42 CFR 447.45(b); or
(B) under review for medical necessity.
As added by P.L.107-1996, SEC.2 and P.L.257-1996, SEC.2.
Structure Indiana Code
Chapter 13. Provider Payment; General
12-15-13-0.1. Application of Certain Amendments to Chapter
12-15-13-0.6. "Clean Claim" for Purposes of Ic 12-15-14
12-15-13-0.7. Addition, Deletion, or Modification of Locators
12-15-13-1.5. Payment of Interest on Claims Submitted by Nursing Facilities
12-15-13-1.6. Payment, Denial, or Suspension of Claims; Notice of Suspension or Denial
12-15-13-1.7. Timing of Payment or Denial of Claims; Payment of Interest
12-15-13-3.5. Recovery of Overpayment to Noninstitutional Provider; Appeal
12-15-13-4. Recovery of Overpayment to Institutional Provider; Appeal
12-15-13-6. Notices or Bulletins; Timing; Noncompliance