Indiana Code 27-8-5.7-5. Notice of deficiencies in claims

Sec. 5. (a) An insurer shall pay or deny each clean claim in accordance with sections 6 and 6.5 of this chapter.

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clean claim: means a claim submitted by a provider for payment under an accident and sickness insurance policy issued in Indiana that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. See Indiana Code 27-8-5.7-2
insurer: means an insurance company issued a certificate of authority in Indiana to issue accident and sickness insurance policies. See Indiana Code 27-8-5.7-3
provider: has the meaning set forth in IC 27-8-11-1. See Indiana Code 27-8-5.7-4

(b) An insurer 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 insurer 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.5. Amended by P.L.137-2002, SEC.2; P.L.190-2023, SEC.27.