Sec. 0.6. (a) “Clean claim”, as the term applies to payments to nursing facilities under IC 12-15-14, means a claim submitted by a provider for payment that meets the following conditions:

(1) Contains the following locators:

(A) Type of bill.

(B) Coverage dates.

(C) Bill status.

(D) Revenue codes.

(E) Rate of payment.

(F) Service units.

(G) Total charges.

(H) Provider number.

(I) Third party prior payments.

(J) Estimated amount due.

(K) Recipient number.

(L) Provider signature.

(M) Provider name.

(N) Number of covered days of service.

(O) Date of admission.

(P) Condition codes.

(Q) Occurrence codes and dates.

(R) Value codes and amounts.

(S) Third party liability payor name.

(T) Recipient name.

(U) Admitting diagnosis.

(V) Attending physician ID number.

(2) Has correct and valid information for each of the locators required by subdivision (1).

(3) The recipient for whom the claim is submitted is eligible for Medicaid on the date for which the service is billed.

(4) The office has approved the level of care for:

(A) the recipient; and

(B) the facility;

for the dates for which the service is billed.

(5) The provider is eligible to render service on the date for which the service is billed.

(6) The claim does not duplicate a claim already paid.

     (b) The definition under subsection (a):

(1) includes a claim with errors originating in the state’s claims processing system; and

(2) does not include a claim:

(A) from a provider who is under investigation for fraud or abuse (as used in 42 C.F.R. § 447.45(b)); or

(B) under review for medical necessity.

As added by P.L.107-1996, SEC.3 and P.L.257-1996, SEC.3.