Sec. 5. A provider shall submit only the following forms for payment by a health maintenance organization: (1) CMS-1500. (2) CMS-1450 (UB-04). (3) American Dental Association (ADA) claim form. As added by P.L.162-2001, SEC.6. Amended by P.L.208-2018, SEC.32.
Permitted forms
Ind. Code § 27-13-36.2-5, under Provider Payment.
Ind. Code § 27-13-36.2-5