62A.317 STANDARDS FOR CLAIMS PAYMENT.
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62A.317 STANDARDS FOR CLAIMS PAYMENT.
(a)An issuer shall comply with section 1882(c)(3) of the federal Social Security Act, as enacted by section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA), Public Law 100-203, by:
(1)accepting a notice from a Medicare carrier on duly assigned claims submitted by Medicare participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and making a payment determination on the basis of the information contained in that notice;
(2)notifying the Medicare participating physician or supplier and the beneficiary of the payment determination;
(3)paying the Medicare participating physician or supplier directly;
(4)furnishing, at the time of enrollment, each enrollee with a card listing the policy or certificate name, number, and a central mailing address to which notices from a Medicare carrier may be sent;
(5)paying user fees for claim notices that are transmitted electronically or otherwise; and
(6)providing to the secretary of health and human services, at least annually, a central mailing address to which all claims may be sent by Medicare carriers.
(b)Compliance with the requirements in paragraph
(a)shall be certified on the Medicare supplement insurance experience reporting form.