KRS 304.14-135: Uniform health insurance claim forms.

(1) The commissioner shall prescribe the following uniform health insurance claim

forms which shall be used by all insurers transacting health insurance in this state

and by all state agencies that require health insurance claim forms for their records

as the sole instrument for reimbursement:

(a) The uniform health insurance claim form for an institutional provider shall

consist of the UB -92 data set or its successor submitted on the designated

paper or electronic format as adopted by the National Uniform Bill ing

Committee;

(b) The uniform health insurance claim form for a dentist shall consist of a data

set and form approved by the American Dental Association;

(c) The uniform health insurance claim form for all other health care providers

shall consist of the HCFA 1500 data set or its successor submitted on the

designated paper or electronic format as adopted by the National Uniform

Claim Committee; and

(d) A clean claim for pharmacists shall consist of:

1. For prescription drug claims, a universal claim form a nd data set

approved by the National Council for Prescription Drug Programs; and

2. For all other claims for services or procedures that are within the scope

of the practice of pharmacy, as defined in KRS 315.010, a 1500 Health

Insurance Claim Form or its successor submitted on the designated

paper or electronic format as adopted by the National Uniform Claim

Committee.

(2) An insurer shall not require a provider to:

(a) Use a claim form that is different than the uniform claim form for the provider

type as set out in subsection (1) of this section;

(b) Modify the uniform claims form or its content; or

(c) Submit additional claims forms.