Ind. Code § 16-51-1-5

"Individual provider form"

As added by P.L.203-2023, SEC.18.
  1. (a) As used in this chapter, "individual provider form" means a medical claim form that:

    1. (1) is accepted by the federal Centers for Medicare and Medicaid Services for use by individual providers or groups of providers; and
    2. (2) includes a claim field for disclosure of the site at which the health care services to which the form relates were provided.
  2. (b) The term includes the following:

    1. (1) The CMS-1500 form or its successor form.
    2. (2) The HCFA-1500 form or its successor form.
    3. (3) The HIPAA X12 837P electronic claims transaction for professional services, or its successor transaction.

As added by P.L.203-2023, SEC.18.

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