CHAPTER 8.1. STATE EMPLOYEE HEALTH BENEFITS; PROVIDER PAYMENT

IC 5-10-8.1
    Chapter 8.1. State Employee Health Benefits; Provider Payment

IC 5-10-8.1-1
"Administrator" defined
    Sec. 1. As used in this chapter, "administrator" means:
        (1) the state personnel department;
        (2) an entity with which the state contracts to administer healthcoverage under IC 5-10-8-7(b); or
        (3) a prepaid health care delivery plan with which the statecontracts under IC 5-10-8-7(c).
As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-2
"Clean claim" defined
    Sec. 2. As used in this chapter, "clean claim" means a claimsubmitted by a provider for payment under a health benefit plan thathas no defect, impropriety, or particular circumstance requiringspecial treatment preventing payment.
As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-3
"Covered individual" defined
    Sec. 3. As used in this chapter, "covered individual" means anindividual who is:
        (1) covered under a self-insurance program established underIC 5-10-8-7(b) to provide group health coverage; or
        (2) entitled to services under a contract for health servicesentered into or renewed under IC 5-10-8-7(c).
As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-4
"Health benefit plan" defined
    Sec. 4. As used in this chapter, "health benefit plan" means aself-insurance program established to provide group health coverageas described in IC 5-10-8-7(b), or a contract for health services asdescribed in IC 5-10-8-7(c).
As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-5
"Provider" defined
    Sec. 5. As used in this chapter, "provider" has the meaning setforth in IC 27-8-11-1.
As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-6
Notice of deficiencies in claims
    Sec. 6. (a) The administrator shall pay or deny each clean claimin accordance with section 7 of this chapter.
    (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 requiredunder 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.

IC 5-10-8.1-7
Payment or denial of claims; interest
    Sec. 7. (a) The administrator shall pay or deny each clean claimas follows:
        (1) If the claim is filed electronically, not more than thirty (30)days after the date the claim is received by the administrator.
        (2) If the claim is filed on paper, not more than forty-five (45)days after the date the claim is received by the administrator.
    (b) If:
        (1) the administrator fails to pay or deny a clean claim in thetime required under subsection (a); and
        (2) the administrator subsequently pays the claim;
the administrator shall pay the provider that submitted the claiminterest on the health benefit plan allowable amount of the claim paidunder this section.
    (c) Interest paid under subsection (b):
        (1) accrues beginning:
            (A) thirty-one (31) days after the date the claim is filedunder subsection (a)(1); or
            (B) forty-six (46) days after the date the claim is filed undersubsection (a)(2); and
        (2) stops accruing on the date the claim is paid.
    (d) In paying interest under subsection (b), the administrator shalluse the same interest rate as provided in IC 12-15-21-3(7)(A).
As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-8
Permitted forms
    Sec. 8. A provider shall submit only the following forms forpayment by an administrator:
        (1) HCFA-1500.
        (2) HCFA-1450 (UB-92).
        (3) American Dental Association (ADA) claim form.
As added by P.L.162-2001, SEC.1.