SOURCE: Page 16, line 14; (02)MO027602.16. -->
Page 16, between lines 14 and 15, begin a new paragraph and insert:
SOURCE: IC 27-13-36-9.5; (02)MO027602.6. -->
"SECTION 6. IC 27-13-36-9.5 IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2002]:
Sec. 9.5. (a) Notwithstanding
IC 27-13-36.2, a provider who is not a participating provider and
who provides services, including emergency services, that a health
maintenance organization or a limited service health maintenance
organization is required to pay a nonparticipating provider, is
considered to have filed a proper and complete claim if the
provider submits the following information:
(1) The name of the enrollee who received services.
(2) The address of the enrollee.
(3) The date of service.
(4) The Current Procedural Terminology (CPT) code.
(5) The International Classification of Diseases (ICD) disease
classification.
(6) The name and address of the provider.
(7) Information on the enrollee's benefit card that is specific
to the enrollee.
(8) Tax identification information of the provider.
(b) A claim for an evaluation and management code (as defined
by the latest edition of the Current Procedural Terminology
Manual) that meets the requirements under subsection (a) must be
paid to the provider not more than fourteen (14) days after the
claim is submitted.
(c) If a claim is not for an evaluation and management code (as
defined by the latest edition of the Current Procedural
Terminology Manual), the health maintenance organization or the
limited service health maintenance organization may require the
provider to submit information in addition to the information
required under subsection (a). However, the request for additional
information under this subsection must be made not more than
thirty (30) days after the provider has submitted a claim or the
claim must be paid.".
Renumber all SECTIONS consecutively.
(Reference is to ESB 276 as printed February 19, 2002.)
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MO027602/DI 104 2002