Payment, Denial, or Suspension of Claims Submitted by Nursing Facilities; Time; Notice of Suspension or Denial

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Sec. 1. (a) This section applies only to claims submitted for payment by nursing facilities.

(b) The office shall pay, deny, or suspend each claim submitted by a provider for payment under the Medicaid program not more than:

(1) twenty-one (21) days after the date a claim that is filed electronically; or

(2) thirty (30) days after the date a claim that is filed on paper;

is received by the office or, if IC 12-15-30 applies, by the contractor under IC 12-15-30.

(c) The office shall pay each clean claim.

(d) The office may deny or suspend a claim that is not a clean claim. If the office denies a provider's claim for payment, the office shall notify the provider of each reason the claim was denied.

(e) If the office suspends a provider's claim for payment under the Medicaid program, the office shall notify the provider of each reason the claim was suspended.

[Pre-1992 Revision Citation: 12-1-7-16.5.]

As added by P.L.2-1992, SEC.9. Amended by P.L.10-1994, SEC.4; P.L.107-1996, SEC.5; P.L.257-1996, SEC.5.


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