IC 16-51-1-5: "Individual provider form"

Sec. 5. (a) As used in this chapter, "individual provider form" means a medical claim form that:

(1) is accepted by the federal Centers for Medicare and Medicaid Services for use by individual providers or groups of providers; and

(2) includes a claim field for disclosure of the site at which the health care services to which the form relates were provided.

(b) The term includes the following:

(1) The CMS-1500 form or its successor form.

(2) The HCFA-1500 form or its successor form.

(3) The HIPAA X12 837P electronic claims transaction for professional services, or its successor transaction.