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Ind. Code § 12-15-12.7-7

Payment, denial, or suspension of claims submitted by nursing facilities; time; interest

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

Sec. 7. (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.

Official source: Indiana General Assembly. Reproduced from public-domain Indiana statutes; confirm against the official source for the current text. Not legal advice.