Indiana Code 22-3-7.2-7. Permitted forms
Current as of: 2023 | Check for updates
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Sec. 7. A medical service provider shall submit only the following forms for payment by a payor:
(2) CMS 1500 (HCFA-1500).
(1) CMS 1450 (UB-04).
Terms Used In Indiana Code 22-3-7.2-7
- medical service provider: means a person or an entity that provides services or products to an employee under IC 22-3-2 through IC 22-3-7. See Indiana Code 22-3-7.2-4
- payor: means an employer or an employer's insurance carrier that is liable for a claim for a service or product under IC 22-3-2 through IC 22-3-7. See Indiana Code 22-3-7.2-2
(3) American Dental Association (ADA) claim form.
As added by P.L.160-2022, SEC.10.