2016 Indiana Code TITLE 5. STATE AND LOCAL ADMINISTRATION ARTICLE 10. PUBLIC EMPLOYEE BENEFITS CHAPTER 8.1. STATE EMPLOYEE HEALTH BENEFITS; PROVIDER PAYMENT
Download as PDF
IC 5-10-8.1
Chapter 8.1. State Employee Health Benefits; Provider
Payment
IC 5-10-8.1-1
"Administrator" defined
Sec. 1. As used in this chapter, "administrator" means:
(1) the state personnel department;
(2) an entity with which the state contracts to administer health
coverage under IC 5-10-8-7(b); or
(3) a prepaid health care delivery plan with which the state
contracts under IC 5-10-8-7(c).
As added by P.L.162-2001, SEC.1.
IC 5-10-8.1-2
"Clean claim" defined
Sec. 2. As used in this chapter, "clean claim" means a claim
submitted by a provider for payment under a health benefit plan that
has no defect, impropriety, or particular circumstance requiring
special treatment preventing payment.
As added by P.L.162-2001, SEC.1.
IC 5-10-8.1-3
"Covered individual" defined
Sec. 3. As used in this chapter, "covered individual" means an
individual who is:
(1) covered under a self-insurance program established under
IC 5-10-8-7(b) to provide group health coverage; or
(2) entitled to services under a contract for health services
entered into or renewed under IC 5-10-8-7(c).
As added by P.L.162-2001, SEC.1.
IC 5-10-8.1-4
"Health benefit plan" defined
Sec. 4. As used in this chapter, "health benefit plan" means a
self-insurance program established to provide group health coverage
as described in IC 5-10-8-7(b), or a contract for health services as
described in IC 5-10-8-7(c).
As added by P.L.162-2001, SEC.1.
IC 5-10-8.1-5
"Provider" defined
Sec. 5. As used in this chapter, "provider" has the meaning set
forth in IC 27-8-11-1.
As added by P.L.162-2001, SEC.1.
IC 5-10-8.1-6
Notice of deficiencies in claims
Indiana Code 2016
Sec. 6. (a) The administrator shall pay or deny each clean claim
in accordance with section 7 of this chapter.
(b) An administrator shall notify a provider of any deficiencies in
a submitted claim not more than:
(1) thirty (30) days for a claim that is filed electronically; or
(2) forty-five (45) days for a claim that is filed on paper;
and describe any remedy necessary to establish a clean claim.
(c) Failure of an administrator to notify a provider as required
under subsection (b) establishes the submitted claim as a clean claim.
As added by P.L.162-2001, SEC.1. Amended by P.L.137-2002,
SEC.1.
IC 5-10-8.1-7
Payment or denial of claims; interest
Sec. 7. (a) The administrator shall pay or deny each clean claim
as follows:
(1) If the claim is filed electronically, not more than thirty (30)
days after the date the claim is received by the administrator.
(2) If the claim is filed on paper, not more than forty-five (45)
days after the date the claim is received by the administrator.
(b) If:
(1) the administrator fails to pay or deny a clean claim in the
time required under subsection (a); and
(2) the administrator subsequently pays the claim;
the administrator shall pay the provider that submitted the claim
interest on the health benefit plan allowable amount of the claim paid
under this section.
(c) Interest paid under subsection (b):
(1) accrues beginning:
(A) thirty-one (31) days after the date the claim is filed
under subsection (a)(1); or
(B) forty-six (46) days after the date the claim is filed under
subsection (a)(2); and
(2) stops accruing on the date the claim is paid.
(d) In paying interest under subsection (b), the administrator shall
use the same interest rate as provided in IC 12-15-21-3(7)(A).
As added by P.L.162-2001, SEC.1.
IC 5-10-8.1-8
Permitted forms
Sec. 8. A provider shall submit only the following forms for
payment by an administrator:
(1) HCFA-1500.
(2) HCFA-1450 (UB-92).
(3) American Dental Association (ADA) claim form.
As added by P.L.162-2001, SEC.1.
Indiana Code 2016
Disclaimer: These codes may not be the most recent version. Indiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
