GroundRules
IC 22-3-7.2-7: Permitted forms
Where this section sits in the code
- TITLE 22. LABOR AND SAFETY
- ARTICLE 3. WORKER'S COMPENSATION SYSTEM
- Chapter 7.2. Payments of Claims
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.
Collected 2026-08-18T00:45:42Z. Source file · JSON