Sec. 3. (a) A health maintenance organization shall pay or deny each clean claim in accordance with section 4 of this chapter.

lawyer at desk

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Indiana Code 27-13-36.2-3

  • clean claim: means a claim submitted by a provider for payment for health care services provided to an enrollee that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. See Indiana Code 27-13-36.2-1
  • health maintenance organization: includes :

    Indiana Code 27-13-36.2-2

     (b) A health maintenance organization 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 a health maintenance organization 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.6. Amended by P.L.137-2002, SEC.3.

  Previous section
Next section  
 Chapter 36.2 Contents