Sec. 12. (a) As used in this section, "nonparticipating provider" means a provider that has not entered into an agreement with a health maintenance organization to serve as a participating provider. (b) After September 30, 2009, if a health maintenance organization makes a payment to an enrollee for a health care service rendered by a nonparticipating provider, the health maintenance organization shall include with the payment instrument written notice to the enrollee that includes the following: (1) A statement specifying the claims covered by the payment instrument. (2) The name and address of the provider submitting each claim. (3) The amount paid by the health maintenance organization for each claim. (4) Any amount of a claim that is the enrollee's responsibility. (5) A statement in at least 24 point bold type that: (A) instructs the enrollee to use the payment to pay the nonparticipating provider if the enrollee has not paid the nonparticipating provider in full; (B) specifies that paying the nonparticipating provider is the enrollee's responsibility; and (C) states that the failure to make the payment violates the law and may result in collection proceedings or criminal penalties. IC 27-13-36.2 Chapter 36.2. Provider Payment 27-13-36.2-1 "Clean claim" defined 27-13-36.2-2 "Health maintenance organization" defined 27-13-36.2-3 Notice of deficiencies in claims 27-13-36.2-4 Payment or denial of claims; interest 27-13-36.2-4.5 Prohibition on altering CPT code for claim; exceptions 27-13-36.2-5 Permitted forms 27-13-36.2-6 Civil penalties 27-13-36.2-7 Repealed 27-13-36.2-8 Claim payment errors 27-13-36.2-9 Claim overpayment adjustment 27-13-36.2-10 Prohibition on denial of claim based on out of network provider referral
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