- (1) The purpose of this rule is to designate uniform claim forms, billing codes, and compatible electronic data interchange standards for use by health payers and providers.
- (2) This rule applies to a health claim, a health encounter, and any electronic data interchange between a payer and a provider.
- (3) Except as otherwise specifically provided, this rule applies to a payer and a provider.
- (4) This rule does not prohibit a payer from requesting additional information to determine eligibility of a claim under the terms of the policy or certificate issued to the claimant.
- (5) This rule does not prohibit a payer or provider from using alternative forms or procedures specified in a written contract between the payer and provider.
- (6) This rule does not exempt a payer or provider from data reporting requirements under state or federal law or regulation.
KEY: insurance law
Date of Last Change: December 11, 2024
Notice of Continuation: March 3, 2025
Authorizing, and Implemented or Interpreted Law: 31A-22-614.5