§ 304-14-135

304.14 -135 Uniform health insurance claim forms. (1) The commissioner shall prescribe the following uniform health insurance claim forms which shall be used by all insurers transacting health insurance in this state and by all state agencies that require health insurance claim forms for their records as the sole instrument for reimbursement: (a) The uniform health insurance claim form for an institutional provider shall consist of the UB -92 data set or its successor submitted on the designated paper or electronic format as adopted by the National Uniform Bill ing Committee; (b) The uniform health insurance claim form for a dentist shall consist of a data set and form approved by the American Dental Association; (c) The uniform health insurance claim form for all other health care providers shall consist of the HCFA 1500 data set or its successor submitted on the designated paper or electronic format as adopted by the National Uniform Claim Committee; and (d) A clean claim for pharmacists shall consist of: 1. For prescription drug claims, a universal claim form a nd data set approved by the National Council for Prescription Drug Programs; and 2.

; and (d) A clean claim for pharmacists shall consist of: 1. For prescription drug claims, a universal claim form a nd data set approved by the National Council for Prescription Drug Programs; and 2. For all other claims for services or procedures that are within the scope of the practice of pharmacy, as defined in KRS 315.010, a 1500 Health Insurance Claim Form or its successor submitted on the designated paper or electronic format as adopted by the National Uniform Claim Committee. (2) An insurer shall not require a provider to: (a) Use a claim form that is different than the uniform claim form for the provider type as set out in subsection (1) of this section; (b) Modify the uniform claims form or its content; or (c) Submit additional claims forms. Effective: June 29, 2021 History: Amended 2021 Ky. Acts ch. 30, sec. 2, effective June 29, 2021. -- Amended 2010 Ky. Acts ch. 24, sec. 1152, effective July 15, 2010. -- Amended 2000 Ky. Acts ch. 436, sec. 18, effective July 14, 2000. -- Created 1980 Ky. Acts ch. 8, sec. 1, effective July 1 , 1982.