R590-164-2. Purpose and Scope

(1) The purpose of this rule is to designate uniform claim forms, billing codes, and compatible electronic data interchange standards for use by health payers and providers. (2) This rule applies to a health claim, a health encounter, and any electronic data interchange between a payer and a provider. (3) Except as otherwise specifically provided, this rule applies to a payer and a provider. (4) This rule does not prohibit a payer from requesting additional information to determine eligibility of a claim under the terms of the policy or certificate issued to the claimant. (5) This rule does not prohibit a payer or provider from using alternative forms or procedures specified in a written contract between the payer and provider. (6) This rule does not exempt a payer or provider from data reporting requirements under state or federal law or regulation.