§ 12-15-12.7-7 — Payment, denial, or suspension of claims submitted by nursing facilities; time; interest

Indiana § 12-15-12.7-7

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 12.7: Pathways for Aging Risk Based Managed Care

Text

(a) This section applies to claims submitted
for payment under the program by a nursing facility participating in the
program.
(b) The managed care organization shall pay, deny, or suspend each
claim submitted by a nursing facility provider for payment under the
program not later than:
(1) twenty-one (21) days after the claim was electronically filed;
or
(2) thirty (30) days after a claim has been filed on paper;
from receipt by the managed care organization.
(c) If the managed care organization:
(1) fails to pay a clean claim in the time required under this
section; or
(2) denies or suspends a claim that is subsequently determined to
have been a clean claim when the claim was filed;
the managed care organization shall pay the provider interest on the
Medicaid allowable amount of the claim as set forth in this section.
(d) Interest paid under subsection (c):
(1) accrues beginning:
(A) twenty-two (22) days from the date the claim is filed under
subsection (b)(1); or
(B) thirty-one (31) days from the date the claim is filed under
subsection (b)(2); and
(2) stops accruing on the date the managed care organization pays
the claim.
(e) A managed care organization shall pay interest under subsection
(c) to a provider at the rate established for Medicare overpayments and
underpayments, as set forth in 42 CFR 405.378.

Legislative History

As added by P.L.174-2025, SEC.41.