405 IAC 1-1.6-5 Supporting documentation for claims; final determination

Sec. 5. (a) A claim that is finally determined through the claim resolution procedure not to lack sufficient supporting documentation shall be processed by the MCO within thirty (30) days after such final determination. (b) If it is finally determined that a claim lacks sufficient supporting documentation, the provider shall have thirty (30) days after receipt of written notice of the final determination to submit the requisite supporting documentation. The claim shall be processed by the MCO within thirty (30) days after the provider submits to the MCO the required supporting documentation.