Sec. 5. A provider shall submit only the following forms for payment by a health maintenance organization:
(1) CMS-1500.
(2) CMS-1450 (UB-04).
(3) American Dental Association (ADA) claim form.
As added by P.L.162-2001, SEC.6. Amended by P.L.208-2018, SEC.32.
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