Indiana § 22-3-7-38 - Application of law

§ 22-3-7-38. Application of law

Sec. 38. Acts 1937, c.69, s.31 does not extinguish or in any way affect any right of action existing on June 7, 1937, and no employer shall be liable for compensation or damages under the provisions of this chapter in any case in which the disablement on which claim is predicated shall have occurred prior to June 7, 1937; but nothing contained in this section shall affect any case in which exposure as defined in this chapter shall have taken place after June 7, 1937.

Formerly: Acts 1937, c.69, s.32. As amended by P.L.144-1986, SEC.75.

IC 22-3-7.2Chapter 7.2. Payments of Claims

22-3-7.2-1"Clean claim" 22-3-7.2-2"Payor" 22-3-7.2-3"Medical service facility" 22-3-7.2-4"Medical service provider" 22-3-7.2-5Notice of deficiencies in claims 22-3-7.2-6Payment or denial of claims; interest 22-3-7.2-7Permitted forms

IC 22-3-7.2-1"Clean claim" Sec. 1. As used in this chapter, "clean claim" means a claim submitted by a medical service provider for payment under IC 22-3-2 through IC 22-3-7 that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment.

As added by P.L.160-2022, SEC.10.

IC 22-3-7.2-2"Payor" Sec. 2. As used in this chapter, "payor" means an employer or an employer's insurance carrier that is liable for a claim for a service or product under IC 22-3-2 through IC 22-3-7.

As added by P.L.160-2022, SEC.10.

IC 22-3-7.2-3"Medical service facility" Sec. 3. As used in this chapter, "medical service facility" means any of the following that provides a service or product under IC 22-3-2 through IC 22-3-7 and uses the CMS 1450 (UB-04) form or the CMS 1500 (HCFA-1500) form for Medicare reimbursement:

(1) An ambulatory outpatient surgical center (as defined in IC 16-18-2-14).

(2) A hospital (as defined in IC 16-18-2-179).

(3) A hospital based health facility (as defined in IC 16-18-2-180).

(4) A medical center (as defined in IC 16-18-2-223.4).

As added by P.L.160-2022, SEC.10.

IC 22-3-7.2-4"Medical service provider" Sec. 4. As used in this chapter, "medical service provider" means a person or an entity that provides services or products to an employee under IC 22-3-2 through IC 22-3-7. Except as otherwise provided in this chapter, the term includes a medical service facility.

As added by P.L.160-2022, SEC.10.

IC 22-3-7.2-5Notice of deficiencies in claims Sec. 5. (a) A payor shall pay or deny each clean claim in accordance with section 6 of this chapter.

(b) A payor shall notify a medical service provider of any deficiencies in a submitted claim not more than:

(1) thirty (30) days after the date the claim is received by the payor, for a claim that is filed electronically; or

(2) forty-five (45) days after the date the claim is received by the payor, for a claim that is filed on paper;

and describe any remedy necessary to establish a clean claim.

(c) Failure of a payor to notify a medical service provider as required under subsection (b) establishes the submitted claim as a clean claim.

As added by P.L.160-2022, SEC.10.

IC 22-3-7.2-6Payment or denial of claims; interest Sec. 6. (a) A payor shall pay or deny each clean claim as follows:

(1) If the claim is filed electronically, not more than thirty (30) days after the date the claim is received by the payor.

(2) If the claim is filed on paper, not more than forty-five (45) days after the date the claim is received by the payor.

(b) If:

(1) a payor fails to pay or deny a clean claim in the time required under subsection (a); and

(2) the payor subsequently pays the claim;

the payor shall pay the medical service provider that submitted the claim interest on the amount of the payor's pecuniary liability under IC 22-3-2 through IC 22-3-7 for the claim paid under this section.

(c) Interest paid under subsection (b):

(1) accrues beginning:

(A) thirty-one (31) days after the date the claim is received under subsection (a)(1); or

(B) forty-six (46) days after the date the claim is received under subsection (a)(2); and

(2) stops accruing on the date the claim is paid.

(d) In paying interest under subsection (b), a payor shall use the same interest rate as provided in IC 12-15-21-3(7)(A).

As added by P.L.160-2022, SEC.10.

IC 22-3-7.2-7Permitted forms Sec. 7. A medical service provider shall submit only the following forms for payment by a payor:

(1) CMS 1450 (UB-04).

(2) CMS 1500 (HCFA-1500).

(3) American Dental Association (ADA) claim form.

As added by P.L.160-2022, SEC.10.

IC 22-3-8Chapter 8. Representation Before Worker's Compensation Board

22-3-8-1Attorneys; qualifications 22-3-8-2Attorneys; registration; oath; records