Ind. Admin. Code tit. 405, r. 10-9-4 – Provider reimbursement; managed care organizations

Sec. 4. (a) Reimbursement matters including:

(1) the time limit for filing claims; and
(2) rates paid to providers contracting with managed care organizations;

shall be governed by the contract between the provider and the managed care organization.

(b) Reimbursement rates paid by managed care organizations to providers without contracts who render services to plan members shall be at plan reimbursement rates governed by IC 12-15-44.5-5.

(c) No provider retains any independent or duplicative right for reimbursement from the office in addition to or in lieu of reimbursement received from the managed care organization.

(Office of the Secretary of Family and Social Services; 405 IAC 10-9-4; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA; filed Jan 19, 2018, 8:42 a.m.: 20180214-IR-405170484FRA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR-405230817RFA)