Indiana Code 27-1-2.3-8.3. Procedures for remitting payment to a nonparticipating ambulance provider for claims
(1) shall remit payment for the ambulance service directly to the nonparticipating ambulance service provider not more than thirty (30) days after receiving the clean claim; and
Terms Used In Indiana Code 27-1-2.3-8.3
- ambulance service provider: means a person that:
Indiana Code 27-1-2.3-2
- clean claim: means a claim for payment for ambulance service:
Indiana Code 27-1-2.3-2.8
- covered individual: means an individual who is entitled to coverage under a health plan. See Indiana Code 27-1-2.3-3
- health plan: means any of the following:
Indiana Code 27-1-2.3-4
- health plan operator: means the following:
Indiana Code 27-1-2.3-5
(b) If a claim that a health plan operator receives for ambulance service provided to a covered individual by a nonparticipating ambulance service provider is not a clean claim, the health plan operator, not more than thirty (30) days after receiving the claim, shall:
(1) remit payment for the ambulance service directly to the nonparticipating ambulance service provider; or
(2) send to the nonparticipating ambulance service provider a written notice that:
(A) acknowledges the date of the receipt of the claim; and
(B) either:
(i) states that the health plan operator is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full; or
(ii) states that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.
As added by P.L.163-2024, SEC.12.