27-13-36.2-5. Permitted forms

IN Code § 27-13-36.2-5 (2019) (N/A)
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Sec. 5. 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.