Ind. Code § 22-3-7.2-7 – Permitted forms | Midpage

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Indiana Code

§ 7

Ind. Code § 22-3-7.2-7

Permitted forms

As added by P.L.160-2022, SEC.10.

Versions (2)

As of

Dec 31, 2023Current
Dec 31, 2022

A medical service provider shall submit only the following forms for payment by a payor:

(1) CMS 1450 (UB-04).
(2) CMS 1500 (HCFA-1500).
(3) American Dental Association (ADA) claim form.

As added by P.L.160-2022, SEC.10.