Sec. 3. (a) A health maintenance organization shall pay or deny each clean claim in accordance with section 4 of this chapter.
(b) A health maintenance organization shall notify a provider of any deficiencies in a submitted claim not more than:
(1) thirty (30) days for a claim that is filed electronically; or
(2) forty-five (45) days for a claim that is filed on paper;
and describe any remedy necessary to establish a clean claim.
(c) Failure of a health maintenance organization to notify a provider as required under subsection (b) establishes the submitted claim as a clean claim.
As added by P.L.162-2001, SEC.6. Amended by P.L.137-2002, SEC.3.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 36.2. Provider Payment
27-13-36.2-1. "Clean Claim" Defined
27-13-36.2-2. "Health Maintenance Organization" Defined
27-13-36.2-3. Notice of Deficiencies in Claims
27-13-36.2-4. Payment or Denial of Claims; Interest