Sec. 0.1. The amendments made to this chapter apply as follows: (1) The amendments made to section 1 of this chapter by P.L.257-1996 apply to provider claims for payment under the Medicaid program under this article after March 31, 1996. (2) The addition of section 1.5 of this chapter by P.L.257-1996 applies to provider claims […]
Sec. 0.4. As used in this chapter, “office” includes the following: (1) The office of the secretary of family and social services. (2) A managed care organization that has contracted with the office of Medicaid policy and planning under this article. (3) A person that has contracted with a managed care organization described in subdivision […]
Sec. 0.5. (a) Except as provided in section 0.6 of this chapter, as used in this chapter, “clean claim” means a claim submitted by a provider for payment under the Medicaid program that can be processed without obtaining additional information from: (1) the provider of the service; or (2) a third party. (b) The definition […]
Sec. 0.6. (a) “Clean claim”, as the term applies to payments to nursing facilities under IC 12-15-14, means a claim submitted by a provider for payment that meets the following conditions: (1) Contains the following locators: (A) Type of bill. (B) Coverage dates. (C) Bill status. (D) Revenue codes. (E) Rate of payment. (F) Service […]
Sec. 0.7. The office may adopt rules under IC 4-22-2 that add, delete, or modify the locators contained in section 0.6(a)(1) of this chapter as necessary to conform with: (1) changes in federal law or regulation; or (2) directives from the United States Centers for Medicare and Medicaid Services. As added by P.L.107-1996, SEC.4 and […]
Sec. 1. (a) This section applies only to claims submitted for payment by nursing facilities. (b) The office shall pay, deny, or suspend each claim submitted by a provider for payment under the Medicaid program not more than: (1) twenty-one (21) days after the date a claim that is filed electronically; or (2) thirty (30) […]
Sec. 1.5. (a) This section applies only to claims submitted for payment by nursing facilities. (b) If the office: (1) fails to pay a clean claim in the time required under section 1(b) of this chapter; or (2) denies or suspends a claim that is subsequently determined to have been a clean claim when the […]
Sec. 1.6. (a) This section does not apply to claims submitted for payment by nursing facilities. (b) The office shall pay or deny each clean claim in accordance with section 1.7 of this chapter. (c) The office shall deny or suspend each claim that is not a clean claim in accordance with subsection (d). (d) […]
Sec. 1.7. (a) This section does not apply to claims submitted for payment by nursing facilities. (b) The office shall pay or deny each clean claim as follows: (1) If the claim is filed electronically, within twenty-one (21) days after the date the claim is received by: (A) the office; or (B) a contractor of […]
Sec. 2. (a) Except as provided in IC 12-15-14 and IC 12-15-15, payments to Medicaid providers must be: (1) consistent with efficiency, economy, and quality of care; and (2) sufficient to enlist enough providers so that care and services are available under Medicaid, at least to the extent that such care and services are available […]
As added by P.L.152-1995, SEC.10. Amended by P.L.107-1996, SEC.9; P.L.257-1996, SEC.9; P.L.78-2004, SEC.3; P.L.8-2005, SEC.1. Repealed by P.L.229-2011, SEC.270.
Sec. 3.5. (a) As used in this section, “noninstitutional provider” means any Medicaid provider other than the following: (1) A health facility licensed under IC 16-28. (2) An ICF/IID (as defined in IC 16-29-4-2). (b) If the office of the secretary or the office of the secretary’s designee believes that an overpayment to a noninstitutional […]
Sec. 4. (a) As used in this section, “institutional provider” means the following: (1) A health facility that is licensed under IC 16-28. (2) An ICF/IID (as defined in IC 16-29-4-2). (b) If the office of the secretary or the office of the secretary’s designee believes that an overpayment to an institutional provider has occurred, […]
As added by P.L.213-2015, SEC.128. Repealed by P.L.12-2016, SEC.9.
Sec. 6. (a) Except as provided by IC 12-15-35-50, a notice or bulletin that is issued by: (1) the office; (2) a contractor of the office; or (3) a managed care organization; concerning a change to the Medicaid program, including a change to prior authorization, claims processing, payment rates, and medical policies, that does not […]
Sec. 7. (a) The office and an entity with which the office contracts for the payment of claims shall accept claims submitted on any of the following forms by an individual or organization that is a contractor or subcontractor of the office: (1) CMS-1500 or its subsequent form. (2) CMS-1450 (UB04) or its subsequent form. […]
Sec. 7.2. (a) As used in this section, “provider” has the meaning set forth in IC 27-8-11-1. (b) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection: (1) the office shall for all purposes begin using the most current version of the: (A) current […]
Sec. 9. (a) Subject to subsection (b), the office shall reimburse the following providers if the providers are providing Medicaid covered services at a federally-qualified health center (as defined in 42 U.S.C. 1396d(l)(2)(B)) or a rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)) within the provider’s scope of practice: (1) A clinical social worker […]
