Sec. 8. A provider shall submit only the following forms for payment by an administrator:
(1) CMS-1500.
(2) CMS-1450 (UB-04).
(3) American Dental Association (ADA) claim form.
As added by P.L.162-2001, SEC.1. Amended by P.L.208-2018, SEC.1.
Structure Indiana Code
Title 5. State and Local Administration
Article 10. Public Employee Benefits
Chapter 8.1. State Employee Health Benefits; Provider Payment
5-10-8.1-1. "Administrator" Defined
5-10-8.1-2. "Clean Claim" Defined
5-10-8.1-3. "Covered Individual" Defined
5-10-8.1-4. "Health Benefit Plan" Defined
5-10-8.1-5. "Provider" Defined
5-10-8.1-6. Notice of Deficiencies in Claims