Indiana Code 27-13-36.2-3. Notice of deficiencies in claims
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Sec. 3. (a) A health maintenance organization shall pay or deny each clean claim in accordance with section 4 of this chapter.
(1) thirty (30) days for a claim that is filed electronically; or
(b) A health maintenance organization shall notify a provider of any deficiencies in a submitted claim not more than:
Terms Used In Indiana Code 27-13-36.2-3
- clean claim: means a claim submitted by a provider for payment for health care services provided to an enrollee that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. See Indiana Code 27-13-36.2-1
- health maintenance organization: includes :
Indiana Code 27-13-36.2-2
(2) forty-five (45) days for a claim that is filed on paper;
and describe any remedy necessary to establish a clean claim.
(c) Failure of a health maintenance organization to notify a provider as required under subsection (b) establishes the submitted claim as a clean claim.
As added by P.L.162-2001, SEC.6. Amended by P.L.137-2002, SEC.3.