Indiana Code
Chapter 13. Provider Payment; General
12-15-13-7. Permitted Forms

Sec. 7. (a) The office and an entity with which the office contracts for the payment of claims shall accept claims submitted on any of the following forms by an individual or organization that is a contractor or subcontractor of the office:
(1) CMS-1500 or its subsequent form.
(2) CMS-1450 (UB04) or its subsequent form.
(3) American Dental Association (ADA) claim form.
(4) Pharmacy and compound drug form.
(b) The office and an entity with which the office contracts for the payment of claims:
(1) may designate as acceptable claim forms other than a form listed in subsection (a); and
(2) may not mandate the use of a crossover claim form.
As added by P.L.256-2001, SEC.3. Amended by P.L.27-2011, SEC.2.