470 IAC 12-1-3 Request forms

Sec. 3. (a) Requests for medical services must be made on forms specified by the department, using procedures developed by the department. (b) Request forms shall contain such information as the department deems necessary to implement the provisions of IC 12-5-7 [IC 12-5 was repealed by P.L.2-1992, SECTION 897, effective February 14, 1992.]. (c) The department is not required to review any request form which is not properly signed and co-signed, and which has not been completed in its entirety. Request forms shall be returned without action if they are incomplete, illegible, or if they bear rubber-stamp; facsimile; machine-drawn, or any other substitute signature.