Indiana Code
Chapter 36.2. Provider Payment
27-13-36.2-5. Permitted Forms

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.