Sec. 4.5. (a) An insurer shall accept a Medicaid claim for a Medicaid recipient for three (3) years from the date the service was provided.
(b) An insurer may not deny a Medicaid claim submitted by the office solely on the basis of:
(1) the date of submission of the claim;
(2) the type or format of the claim form;
(3) the method of submission of the claim; or
(4) a failure to provide proper documentation at the point of sale that is the basis of the claim;
if the claim is submitted by the office within three (3) years from the date the service was provided as required in subsection (a) and the office commences action to enforce the office's rights regarding the claim within six (6) years of the office's submission of the claim.
(c) An insurer may not deny a Medicaid claim submitted by the office solely due to a lack of prior authorization. An insurer shall:
(1) after December 31, 2020, meet the requirements set forth in IC 27-1-37.5;
(2) conduct the prior authorization on a retrospective basis for claims where prior authorization is necessary; and
(3) adjudicate any claim authorized in this manner as if the claim received prior authorization.
As added by P.L.187-2007, SEC.5. Amended by P.L.265-2019, SEC.2.
Structure Indiana Code
12-15-29-1. Insurers; Authorization to Release Information
12-15-29-2. Requests for Information From Insurers; Limitation
12-15-29-3. Guidelines for Information Requests
12-15-29-4. Direct Payments by Insurers to Office; Amount of Payments
12-15-29-4.5. Insurer's Acceptance of Medicaid Claims
12-15-29-6. Payment by Insurer to Office; Discharge of Obligation
12-15-29-8. Unlawful Insurance Clause
12-15-29-9. State's Acquisition of Person's Right to Payment
12-15-29-10. Employer Sponsored Health Insurance to Include Coverage for Child