{"data":{"id":"us-in/ic-22-3-7.2-7","jurisdiction":"us-in","citation":"IC 22-3-7.2-7","heading":"Permitted forms","body":"Sec. 7. A medical service provider shall submit only the following forms for payment by a payor:\n(1) CMS 1450 (UB-04).\n(2) CMS 1500 (HCFA-1500).\n(3) American Dental Association (ADA) claim form.","path":["TITLE 22. LABOR AND SAFETY","ARTICLE 3. WORKER'S COMPENSATION SYSTEM","Chapter 7.2. Payments of Claims"],"source_url":"https://iga.in.gov/ic/2026/Title_22.html#22-3-7.2-7","current_through":"2026","vintage":"2026","retrieved_at":"2026-08-18T00:45:42Z","sha256":"85bd60b0433fdc5f992c4e8ae4e3dfc99da81d45f82008deb7b82f5632a60315","source_id":"us-in","stale":false,"prev":"us-in/ic-22-3-7.2-6","next":"us-in/ic-22-3-8-1"},"notice":"GroundRules: Original legal text. Not legal advice."}