Rules and Regulations of the State of Georgia
 

JavaScript Is Not Enabled alert

You need to have JavaScript enabled in your browser to utilise the full functionality of this website.

How to enable JavaScript in your browser

Internet Explorer Mozilla Firefox Google Chrome Opera Apple Safari




firefox Mozilla Firefox

  1. In the address bar, type about:config and press Enter.
  2. Click "I'll be careful, I promise" if a warning message appears.
  3. In the search box, search for javascript.enabled
  4. Toggle the "javascript.enabled" preference (right-click and select "Toggle" or double-click the preference) to change the value from "false" to "true".
  5. Click on the "Reload current page" button of the web browser to refresh the page.
  • 1. In the address bar, type about:config and press Enter.
  • 2. Click "I'll be careful, I promise" if a warning message appears.
  • 3. In the search box, search for javascript.enabled
  • 4. Toggle the "javascript.enabled" preference (right-click and select "Toggle" or double-click the preference) to change the value from "false" to "true".
  • 5. Click on the "Reload current page" button of the web browser to refresh the page.




ie Internet Explorer

  1. On web browser menu click "Tools" icon and select "Internet Options".
  2. In the "Internet Options" window select the "Security" tab.
  3. On the "Security" tab click on the "Custom level..." button.
  4. When the "Security Settings - Internet Zone" dialog window opens, look for the "Scripting" section.
  5. In the "Active Scripting" item select "Enable".
  6. When the "Warning!" window pops out asking "Are you sure you want to change the settings for this zone?" select "Yes".
  7. In the "Internet Options" window click on the "OK" button to close it.
  8. Click on the "Refresh" button of the web browser to refresh the page.
  • 1. ie9 01
  • 2. ie9 02
  • 3. ie9 03
  • 4. ie9 04
  • 5. ie9 05
  • 6. ie9 06
  • 7. ie9 07
  • 8. ie9 08
 Internet Explorer < 9
  1. On web browser menu click "Tools" and select "Internet Options"
  2. In the "Internet Options" window select the "Security" tab.
  3. On the "Security" tab click on the "Custom level..." button.
  4. When the "Security Settings - Internet Zone" dialog window opens, look for the "Scripting" section.
  5. In the "Active Scripting" item select "Enable".
  6. When the "Warning!" window pops out asking "Are you sure you want to change the settings for this zone?" select "Yes".
  7. In the "Internet Options" window click on the "OK" button to close it.
  8. Click on the "Refresh" button of the web browser to refresh the page.
  • 1. ie 01
  • 2. ie 02
  • 3. ie 03
  • 4. ie 04
  • 5. ie 05
  • 6. ie 06
  • 7. ie 07
  • 8. ie 08




chrome Google Chrome

  1. On the web browser menu click on the "Customize and control Google Chrome" and select "Settings".
  2. In the "Settings" section click on the "Show advanced settings..."
  3. Under the the "Privacy" click on the "Content settings...".
  4. When the dialog window opens, look for the "JavaScript" section and select "Allow all sites to run JavaScript (recommended)".
  5. Click on the "OK" button to close it.
  6. Close the "Settings" tab.
  7. Click on the "Reload this page" button of the web browser to refresh the page.
  • 1. chrome 01
  • 2. chrome 02
  • 3. chrome 03
  • 4. chrome 04
  • 5. chrome 05
  • 6. chrome 06
  • 7. chrome 07




opera Opera

  • 1. a) Click on "Menu", hover mouse on the "Settings" then hover mouse on the "Quick preferences" and mark the "Enable Javascript" checkbox.
  • 1. b) If "Menu bar" is shown click on the "Tools", hover mouse on the "Quick preferences" and mark the "Enable Javascript" checkbox.
1. a) opera10 a 1. b) opera10 b




safari Apple Safari

  1. On the web browser menu click on the "Edit" and select "Preferences".
  2. In the "Preferences" window select the "Security" tab.
  3. In the "Security" tab section "Web content" mark the "Enable JavaScript" checkbox.
  4. Click on the "Reload the current page" button of the web browser to refresh the page.
  • 1. safari 01
  • 2. safari 02
  • 3. safari 03
  • 4. safari 04
<xmp>.</xmp> <form name="form1" method="post" action="120-2-59?urlRedirected=yes&amp;data=admin&amp;lookingfor=120-2-59" id="form1"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUKLTY5ODkwOTM2Nw8WAh4Ec3BhbQIKFgJmD2QWAgIFDw8WAh4EVGV4dAUFNyArIDNkZGSSA2SemQ3UDtRZdqnpMz7aUxhEEA==" /> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="EEBB6393" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWCAKBnLzIBgLniKOhBALV5cpNAoa5iIEFAoznisYGAsrv5u0MAsrv4u0MAsrv3u0MPR+oYc2ZSwgLKwxsXJ0GDaWLZrw=" /> <div class='popup'> <div class='cnt223'> <div style="margin-bottom:6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif"/> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree that you will not copy, print, or download anything from this website for any commercial use. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website.</p> <p> You agree that you will not sell, will not license, and will not otherwise make available in exchange for anything of value, anything that you download, print, or copy from this site.</p> <p> You agree that you will not copy, print, or download any portion of the regulations posted on this site exceeding a single chapter of regulations for sale, license, or other transfer to a third party, except that you may quote a reasonable portion of the regulations in the course of rendering professional advice.</p> <p> If you violate this agreement, or if you access or use this website in violation of this agreement, you agree that Lawriter will suffer damages of at least $20,000. </p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." THE STATE OF GEORGIA AND LAWRITER EXPRESSLY DISCLAIM ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT AND ARE NOT LIABLE TO ANY PERSON FOR ANY ERRORS IN INACCURACIES CONTAINED IN THIS WEBSITE. </p> <p> If you accept these terms enter the information below and click “I AGREE”.</p> </div> <table border="0" style="width: 810px"> <tr> </tr> <tr> <td style="vertical-align: text-top; width: 243px;"> Full Name:</td> <td style="width: 532px; vertical-align:super;"> <input name="firstName" type="text" id="firstName" class="txt" /> <span id="lbl_fname"><font color="Red"></font></span> </td> </tr> <tr><td style="width: 243px"> Human verification: <b> <span id="lblStopSpam">7 + 3</span>&nbsp;= </b></td><td style="width: 532px"> <input name="captcha" type="text" id="captcha" class="txt" /> <span id="lbl_captcha"><font color="Red"></font></span> &nbsp; <input name="sum" type="hidden" id="sum" value="10" /> </td></tr> </table> <input type="submit" name="Button1" value="I AGREE" id="Button1" disabled="disabled" /> <span id="alrtmsg"><font color="Red"></font></span> <input name="v1" type="hidden" id="v1" /> <input name="v2" type="hidden" id="v2" /> <input name="v3" type="hidden" id="v3" /> <p>Privacy Policy: the above information is for internal use only as related to this agreement and will not be sold or distributed.</p> </div> </div> </form> <html> <head runat="server"> <title>GA - GAC</title> <link href="_files/main.css" media="all" rel="Stylesheet" type="text/css" /> <link href="_files/treeview_old.css" media="all" rel="Stylesheet" type="text/css" /> <link href="/_files/popup.css" media="all" rel="stylesheet" type="text/css" /> <script type="text/javascript" src="/_files/treeview.js"></script> <script type="text/javascript" src="/_files/jquery-1.8.0.min.js"></script> <script type="text/javascript" src="/_files/jquery-1.10.2.js"></script> <script type="text/javascript" src="/_files/popup.js"></script> <script type="text/javascript" src="http://code.jquery.com/jquery-1.8.2.js"></script> <script type="text/javascript" src="https://ajax.googleapis.com/ajax/libs/jquery/1.8/jquery.min.js" /> <script type="text/javascript" src="/_files/jquery.popup.js"></script> <script type="text/javascript" src="/_files/jquery.popup.min.js"></script> <script type="text/javascript" src="/_files/ValidateForm.js"></script> <script src="https://code.jquery.com/jquery-1.11.3.js"></script> <link href="/_files/enablejs.css" rel="Stylesheet" type="text/css" /> <link href="/_files/forJavascript.css" rel="Stylesheet" type="text/css" /> <style type="text/css"> .collapse{background-image:url('/images/expcoll_right.png');} .expand{background-image:url('/images/expcoll_down.png');} </style> <script type="text/javascript"> $(document).ready(function(){ $("#History-parent").click(function(){ $("#History-Childs").toggle(); if ($('#History-parent img').hasClass('expand')) { $('#History-parent img').addClass('collapse'); $('#History-parent img').removeClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_right.png'); } else { $('#History-parent img').removeClass('collapse'); $('#History-parent img').addClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_down.png'); } }); $("#History-Childs").hide(); var tocnode=document.getElementById('toc-children'); if (tocnode != null) { if(tocnode.childNodes.length != 0) { document.getElementById("doc-content").style.width="72%"; document.getElementById("toc").style.width="21%"; document.getElementById("toc").style.padding="10px"; } else { document.getElementById('toc').style.display="none"; } } }); function fnsetRDVal(id) { if (id=="y") { document.getElementById("y").value="yes" document.getElementById("n").value="" } else { document.getElementById("n").value="no" document.getElementById("y").value="" } } </script> <script type="text/javascript"> function TermsCon() { var overlay = $('<div id="overlay"></div>'); overlay.show(); overlay.appendTo(document.body); $('.popup2').show(); $('#btnAgree').click(function () { $('.popup2').hide(); $("#overlay").hide(); overlay.appendTo(document.body).remove(); }); $("#btnprint").click(function () { var contents = $("#popupterms").html(); var frame1 = $('<iframe />'); frame1[0].name = "frame1"; frame1.css({ "position": "absolute", "top": "-1000000px" }); $("body").append(frame1); var frameDoc = frame1[0].contentWindow ? frame1[0].contentWindow : frame1[0].contentDocument.document ? frame1[0].contentDocument.document : frame1[0].contentDocument; frameDoc.document.open(); //Create a new HTML document. frameDoc.document.write('<html><head>'); frameDoc.document.write('</head><body>'); //Append the external CSS file. frameDoc.document.write('<link href="_files/popup.css" rel="stylesheet" type="text/css" />'); //Append the DIV contents. frameDoc.document.write(contents); frameDoc.document.write('</body></html>'); frameDoc.document.close(); setTimeout(function () { window.frames["frame1"].focus(); window.frames["frame1"].print(); frame1.remove(); }, 500); }); // alert("Because you do not agree to the Terms and Conditions for Access, you must cease accessing and/or using this website and destroy all material obtained from this website without your agreement."); // $('.popup2').show(); } </script> </head> <body> <div class="popup2"> <div class='cnt2231' id="popupterms"> <div style="margin-bottom: 6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif" /> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll" style="height:100%;"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website. </p> <p> You agree that you will not sell or license anything that you download, print, or copy from this website.</p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." THE STATE OF GEORGIA AND LAWRITER EXPRESSLY DISCLAIM ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT AND ARE NOT LIABLE TO ANY PERSON FOR ANY ERRORS IN INACCURACIES CONTAINED IN THIS WEBSITE. </p> <p> By accessing and/or using this website, you agree to the terms and conditions above. If you do not agree to the terms and conditions above, you must cease accessing and/or using this website and destroy all material obtained from this website without your agreement. </p> </div> </div> <div class="modal-footer"> <input type="button" name="btnAgree" value="Close" id="btnAgree" class="btn-blue noprint" /> <input type="button" name="btnprint" value="Print" id="btnprint" class="btn-blue noprint" /> </div> </div> </div> <div id="main" class="noprint"> <!--class="noprint"--> <div id="header" class="noprint"> <div class="container"> <div class="terms"> NOTICE OF TERMS OF USE OF THIS WEBSITE. By accessing and/or using this website, you agree to the following <a onclick="javascript:TermsCon();" style="text-decoration: underline">terms and conditions.</a> </div> <div class="content"> <div id="logo"> <!--<a href="../" title="Home"><img alt="Rules and Regulations of the State of Georgia" src="/images/garr_logo.gif" /></a>--> <!--<span id="georgia"><a href="/">Rules and Regulations of the State of Georgia</a></span>--> <a href="../" title="Home"><img alt="Rules and Regulations of the State of Georgia" src="/images/ga_rulesreg.gif" /></a> </div> <div id="links"> <a href="../home.aspx" class="constant" title="home">Home</a> | <a href="../gac/" class="constant" title="home">Browse</a> | <a href="../help.aspx" class="constant" title="help">Help</a> | <a href="http://sos.ga.gov/index.php/General/rules_and_regulations" target="_blank" onclick="void(0);" class="constant" title="Georgia SOS">Go to Georgia SOS</a> </div> </div> </div> <div class="sidebar"> <div id="full-text-search"> <form class="searchform" action="../search.aspx" method="get" onsubmit="javascript:return fncheckqts();"> <span class="searchHierarchy" style="margin-right:10px;" > <em class="mnemonic">H</em>ierarchy Search:&nbsp; <input onclick="fnsetRDVal(id);" id="y" checked="checked" type="radio" name="hierarchysearch" value="yes" />&nbsp;Y <input onclick="fnsetRDVal(id);" id="n" type="radio" name="hierarchysearch" value="" />&nbsp;N </span> <input id="query" name="query" class="searchfield" value="Search GA R&R...." onfocus="if (this.value == 'Search GA R&R....') {this.value = '';}" onblur="if (this.value == '') {this.value = 'Search GA R&R....';}" type="text" /> <input class="searchbutton" value="Go" type="submit" /> <input type="hidden" name="searchvalue" value="Subject 120-2-59 STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE" /> <input type="hidden" id="msg" value="REPLACE_MESSAGE" /> <input type="hidden" name="from" value="gac" /> </form> </div> <!--<div id="full-text-search"> <form id="search" action="../search.aspx" method="get" onsubmit="javascript:return fncheckqts();"> <span class="searchHierarchy" style="margin-right:10px;" > <em class="mnemonic">H</em>ierarchy Search:&nbsp; <input onclick="fnsetRDVal(id);" id="y" checked="checked" type="radio" name="hierarchysearch" value="yes" />&nbsp;Y <input onclick="fnsetRDVal(id);" id="n" type="radio" name="hierarchysearch" value="" />&nbsp;N </span> <label for="query" accesskey="s"> <em class="mnemonic">S</em>earch GA R&R: </label><input type="hidden" name="from" value="gac" /> <input id="query" name="query" type="text" /> <input class="submit" value="Go" type="submit" /> <input type="hidden" id="msg" value="REPLACE_MESSAGE" /> <input type="hidden" name="searchlevel" value="REPLACE_SEARCHLEVEL" /> <input type="hidden" name="searchvalue" value="Subject 120-2-59 STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE" /> </form> </div>--> <div id="searchcitation"> <form class="searchform" action="../search.aspx" method="get" onsubmit="javascript:return fnchecks();"> <div> <input id="section" name="section" class="searchfield" value="Go to Citation...." onfocus="if (this.value == 'Go to Citation....') {this.value = '';}" onblur="if (this.value == '') {this.value = 'Go to Citation....';}" type="text" /> <input class="searchbutton" value="Go" type="submit" /> <input type="hidden" name="from" value="gac" /> </div> </form> </div> </div> <HTML xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:msxsl="urn:schemas-microsoft-com:xslt" xmlns:nll="uuid:{D3B28627-934D-41bc-8B7A-0549A8802FE4}"> <HEAD> <META http-equiv="Content-Type" content="text/html; charset=UTF-16"> </HEAD> <div id="infobar"><a href="javascript:;" accesskey="r" Name="Route" title="Route" class="quickkey"><em class="mnemonic">R</em>oute </a>:<div class="searchtips" style="float:right;margin-right:10px;color: rgb(47, 79, 79);"> <a style="text-decoration:none;color: rgb(47, 79, 79);" title="search tips" name="searchtip" href="../help.aspx#searching" target="_blank"><em class="mnemonic">S</em>earch tips</a></div><ul class="breadcrumb"> <li><a href="/GAC" name="GAC" title="GAC">GA R&amp;R</a></li> <li>&raquo; <a href="/GAC/120" title="120">Department 120</a></li> <li>&raquo; <a href="/GAC/120-2" title="120-2">Chapter 120-2</a></li> <li>&raquo; Subject 120-2-59</li> </ul> </div> </div><div id="doc" class="container"> <div id="doc-content" class="content"> <h1><nllsubject>Subject 120-2-59 STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE</nllsubject></h1> <h2><a href="/GAC/120-2-59-.01" name="120-2-59-.01" title="120-2-59-.01">Rule 120-2-59-.01 Authority</a></h2> <P>This Regulation is issued pursuant to the authority vested in the Commissioner of Insurance by O.C.G.A. Sections <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-2-9&amp;title=33#" target="_newtab">33-2-9</a> and 33-24-10.1.</P> <h2><a href="/GAC/120-2-59-.02" name="120-2-59-.02" title="120-2-59-.02">Rule 120-2-59-.02 Purpose</a></h2> <P>The purpose of this Regulation Chapter is to implement the provisions of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, provide for a standardized form to be used in the billing and reimbursement of health care, reduce the number of forms utilized and increase efficiency in the reimbursement of health care through standardization.</P> <h2><a href="/GAC/120-2-59-.03" name="120-2-59-.03" title="120-2-59-.03">Rule 120-2-59-.03 Applicability and Scope</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.03(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except as otherwise specifically provided, this Regulation Chapter shall apply to all issuers, health care practitioners, and institutional care practitioners.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.03(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Nothing in this Regulation Chapter shall prohibit an issuer, health care practitioner or institutional care practitioner from using alternative forms or procedures for filing claims as are specified in a written contract between the health care practitioner or institutional care practitioner and issuer.</td> </tr> </table> <h2><a href="/GAC/120-2-59-.04" name="120-2-59-.04" title="120-2-59-.04">Rule 120-2-59-.04 Definitions</a></h2> <P>For the purposes of O.C.G.A. <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-24-10.1&amp;title=33#" target="_newtab">33-24-10.1</a> and this Regulation Chapter:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "HCFA" means the Health Care Financing Administration of the United States Department of Health and Human Services.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "HCFA Form 1450" means the health insurance claim form maintained by HCFA for use by institutional care practitioners.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "HCFA Form 1500" means the health insurance claim form maintained by HCFA for use by health care practitioners.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Health Care Practitioner" means a health care provider duly licensed by the Secretary of State of the State of Georgia pursuant to the Official Code of Georgia Annotated and the Rules and Regulations of the State of Georgia.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Institutional Care Practitioner" means a hospice, hospital, skilled nursing facility, extended care facility, intermediate care facility, convalescent nursing home, and personal care facility licensed pursuant to the Official Code of Georgia Annotated and the Rules and Regulations of the State of Georgia.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Insured" means an individual covered under a policy of insurance or the provider to which that individual has assigned benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Issuer" means an insurance company, fraternal benefit society, health care service plan, health maintenance organization, third party administrator, and any other entity reimbursing the costs of health care expenses.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.04(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "J512 Form" means the uniform dental claim form approved by the American Dental Association for use by dentists.</td> </tr> </table> <h2><a href="/GAC/120-2-59-.05" name="120-2-59-.05" title="120-2-59-.05">Rule 120-2-59-.05 Requirements</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.05(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Health care practitioners and institutional care practitioners shall use and accept the most current editions of the HCFA Form 1450, HCFA Form 1500, or J512 Form and most current instructions for these forms in the billing of patients or their representatives and filing claims with issuers.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-59-.05(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Issuers shall provide, upon request, to health care practitioners, institutional care practitioners and insureds, and accept the most current editions of the HCFA Form 1450, HCFA Form 1500, or J512 Form for the processing of claims.</td> </tr> </table> <h2><a href="/GAC/120-2-59-.06" name="120-2-59-.06" title="120-2-59-.06">Rule 120-2-59-.06 Severability</a></h2> <P>If any provision of this Regulation Chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the Regulation Chapter and the application of such provision to other persons or circumstances shall not be affected thereby.</P> <P> <P><img class="ImageLink" src="/pdf/ga/admin/2019/120-2-59-.06_001.jpg" alt=" image: ga/admin/2019/120-2-59-.06_001.jpg"></P> </P> <P> <P><img class="ImageLink" src="/pdf/ga/admin/2019/120-2-59-.06_002.jpg" alt=" image: ga/admin/2019/120-2-59-.06_002.jpg"></P> </P> <P> <P><img class="ImageLink" src="/pdf/ga/admin/2019/120-2-59-.06_003.jpg" alt=" image: ga/admin/2019/120-2-59-.06_003.jpg"></P> </P> </div> </div> </HTML> </div> <div id="toc" class="sidebar noprint"> <ul id="toc-children" class="children"><li><a href="/GAC/120-2-59-.01" name="120-2-59-.01" title="120-2-59-.01">Rule 120-2-59-.01 Authority</a></li><li><a href="/GAC/120-2-59-.02" name="120-2-59-.02" title="120-2-59-.02">Rule 120-2-59-.02 Purpose</a></li><li><a href="/GAC/120-2-59-.03" name="120-2-59-.03" title="120-2-59-.03">Rule 120-2-59-.03 Applicability and Scope</a></li><li><a href="/GAC/120-2-59-.04" name="120-2-59-.04" title="120-2-59-.04">Rule 120-2-59-.04 Definitions</a></li><li><a href="/GAC/120-2-59-.05" name="120-2-59-.05" title="120-2-59-.05">Rule 120-2-59-.05 Requirements</a></li><li><a href="/GAC/120-2-59-.06" name="120-2-59-.06" title="120-2-59-.06">Rule 120-2-59-.06 Severability</a></li></ul> </div> </div> <!--content ends here--> <div id="footer" class="noprint"><span class="footer">Copyright &copy; 2019 Lawriter LLC - All rights reserved.</span>| <a href="mailto:support@casemakerlegal.com?subject=Rules and Regulations of the State of Georgia">Email Us</a> | 844-838-0769 | <a href="http://livechat.casemakerlegal.com/client.php?locale=en" target="_blank" onclick="if(navigator.userAgent.toLowerCase().indexOf('opera') != -1 && window.event.preventDefault)window.event.preventDefault();this.newWindow = window.open('http://livechat.casemakerlegal.com/client.php?locale=en&url='+escape(document.location.href)+'&referrer='+escape(document.referrer), 'webim','toolbar=0,scrollbars=0,location=0,status=1,menubar=0,width=640,height=480,resizable=1');this.newWindow.focus();this.newWindow.opener=window;return false;">Live Chat</a> </div> </div> </body> </html>