IC 12-15-12.7-7 — Payment, denial, or suspension of claims submitted by nursing facilities; time; interest
Chapter 12.7. Pathways for Aging Risk Based Managed Care Program
Section text
Sec. 7. (a) This section applies to claims submitted for payment under the program by a nursing facility participating in the program. (b) The managed care organization shall pay, deny, or suspend each claim submitted by a nursing facility provider for payment under the program not later than: (1) twenty-one (21) days after the claim was electronically filed; or (2) thirty (30) days after a claim has been filed on paper; from receipt by the managed care organization. (c) If the managed care organization: (1) fails to pay a clean claim in the time required under this section; or (2) denies or suspends a claim that is subsequently determined to have been a clean claim when the claim was filed; the managed care organization shall pay the provider interest on the Medicaid allowable amount of the claim as set forth in this section. (d) Interest paid under subsection (c): (1) accrues beginning: (A) twenty-two (22) days from the date the claim is filed under subsection (b)(1); or (B) thirty-one (31) days from the date the claim is filed under subsection (b)(2); and (2) stops accruing on the date the managed care organization pays the claim. (e) A managed care organization shall pay interest under subsection (c) to a provider at the rate established for Medicare overpayments and underpayments, as set forth in 42 CFR 405.378.
As added by P.L.174-2025, SEC.41.
Source: official publisher (2026 edition)