Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 1 - MEDICAID PROVIDERS AND SERVICES
Rule 1.6 - Managed Care Provider Reimbursement Dispute Resolution
Section 1.6-2 - Informal objection
Universal Citation: 405 IN Admin Code 1.6-2
Current through March 20, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-15
Sec. 2.
(a) The provider may make verbal inquiries at any time to resolve a claim matter. Before the provider may submit a formal claim appeal under section 3 of this rule, the provider shall attempt to informally resolve the matter as described in this section.
(b) The informal dispute process shall be commenced by a provider submitting a written objection to the MCO, within the following time limits:
(1) If the provider disagrees with the MCO's
determination regarding the provider's claim, the informal process must be
commenced within sixty (60) days after the provider's receipt of written
notification of the MCO's determination.
(2) If the MCO fails to make a determination
within thirty (30) days of the date the claim was submitted, the informal
process must be commenced within ninety (90) days of the date the claim was
submitted to the MCO.
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