Ind. Code § 27-13-36.2-5
Permitted forms
As added by P.L.162-2001, SEC.6. Amended by P.L.208-2018, SEC.32.
A provider shall submit only the following forms for payment by a health maintenance organization:
- (1) CMS-1500.
- (2) CMS-1450 (UB-04).
- (3) American Dental Association (ADA) claim form.
As added by P.L.162-2001, SEC.6. Amended by P.L.208-2018, SEC.32.