Indiana Code 5-10-8.1-6. Notice of deficiencies in claims

Sec. 6. (a) The administrator shall pay or deny each clean claim in accordance with section 7 of this chapter.

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administrator: means :
Indiana Code 5-10-8.1-1
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. See Indiana Code 5-10-8.1-2
provider: has the meaning set forth in IC 27-8-11-1. See Indiana Code 5-10-8.1-5

(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.