Section 470 IAC 11.1-4-1 - Claims submissionsAuthority: IC 12-13-2-3; IC 12-13-5-3
Affected: IC 12-16
Sec. 1.
(a) All claims for payment to providers for medical care rendered in the hospital care for the indigent program shall be submitted upon a form or format approved by the division of family and children or its designee.(b) All "completed" and "approved" claims submitted to the department for hospital admissions occurring in any given state fiscal year must be postmarked or delivered no later than the thirty-first day of October immediately following the state fiscal year in which the admission occurred or said claim shall be disallowed for reimbursement.(c) An "approved" claim as used in this rule, means a claim for a period during which the patient has been determined to be financially and medically eligible for the hospital care for the indigent program.(d) A "completed" claim as used in this rule, means a claim which includes all required information presented timely for payment on forms prescribed by the department.(e) An "amended" claim as used in this rule, means a claim originally presented timely for payment on forms prescribed by the department, returned to the provider by the department, and subsequently resubmitted in accordance with the department's directives to correct the claim. An "amended" claim not received by the department on or before the deadline set out in subsection (b) shall be subject to the deadline for the following year and shall be treated for purposes of payment as a claim originating in the calendar year in which it is accepted by the department as a "completed" and "approved" claim.(f) In the event that a provider is precluded from submitting a "completed" claim by the deadline set out in subsection (b) for the reasons set out below, the deadline shall be waived if the provider can demonstrate to the division's reasonable satisfaction one (1) of the following circumstances: (1) Division of family and children or county office action which prevented the submission of a "completed" claim by the deadline.(2) Continuous, bona fide attempts on the part of the provider to obtain payment from another liable payor.(3) An "amended" claim as described in subsection (e). A cover letter requesting waiver of the deadline, accompanied by appropriate documentation supporting one (1) of the reasons set out in subdivision (1), (2), or (3) must be attached to each claim submitted after the deadline set out in subsection (b).
(g) Claims arising from successful provider or recipient appeals shall be subject to the deadlines and payment schedules set out as follows, in accordance with the date of receipt of the appeal decision:(1) Claims arising from favorable appeal decisions received on or before the fifteenth day prior to the deadline for claims originating in the preceding calendar year shall be subject to the deadline for claims originating in the preceding calendar year. Said claims shall be treated for purposes of payment as claims originating in the preceding calendar year. (2) Claims arising from favorable appeal decisions received after the fifteenth day prior to the deadline for claims originating in the preceding state fiscal year shall be subject to the deadline for claims originating in the state fiscal year in which the appeal decision is received. Said claims shall be treated for purposes of payment as claims originating in the state fiscal year in which the appeal decision is received. A cover letter documenting the appeal decision must accompany each claim submitted as a result of a favorable appeal decision.
Division of Family Resources; 470 IAC 11.1-4-1; filed May 25, 1989, 1:45 p.m.: 12 IR 1860; filed Oct 3, 1997, 4:50 p.m.: 21 IR 377; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA