Sec. 8. A provider shall submit only the following forms for payment by an administrator:

(1) CMS-1500.

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

Terms Used In Indiana Code 5-10-8.1-8

(2) CMS-1450 (UB-04).

(3) American Dental Association (ADA) claim form.

As added by P.L.162-2001, SEC.1. Amended by P.L.208-2018, SEC.1.