Indiana § 12-15-13-0.5 "Clean claim"

Indiana Statutes

§ 12-15-13-0.5 — "Clean claim"

Indiana § 12-15-13-0.5

Art. 15MEDICAID

Ch. 13Provider Payment; General

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Bluebook

Ind. Code § 12-15-13-0.5 (2026).

Text

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 under subsection (a):

(1)includes a claim with errors originating in the state's claims processing system; and

(2)does not include a claim:

(A)from a provider who is under investigation for fraud or abuse (as used in 42 CFR 447.45(b); or

(B)under review for medical necessity.

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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 under subsection (a):
(1) includes a claim with errors originating in the state's claims
processing system; and
(2) does not include a claim:
(A) from a provider who is under investigation for fraud or
abuse (as used in 42 CFR 447.45(b); or
(B) under review for medical necessity.