Indiana Code
Chapter 5.7. Accident and Sickness Insurance; Provider Payment
27-8-5.7-7. Permitted Forms

Sec. 7. A provider shall submit only the following forms for payment by an insurer:
(1) CMS-1500.
(2) CMS-1450 (UB-04).
(3) American Dental Association (ADA) claim form.
As added by P.L.162-2001, SEC.5. Amended by P.L.208-2018, SEC.10.