Sec. 8. A provider shall submit only the following forms for payment by an administrator: (1) CMS-1500. (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.
Permitted forms
Ind. Code § 5-10-8.1-8, under Chapter 8.1. State Employee Health Benefits; Provider Payment.
Ind. Code § 5-10-8.1-8