Section 26-A2211. STANDARDS FOR CLAIMS PAYMENT

 

2211.1An issuer shall comply with section 1882(c) (3) of the Social Security Act (as enacted by section 4081(b) (2) (C) of the Omnibus Budget Reconciliation Act of 1987, Pub. L. No. 100-203) by:

 

(a)Accepting a notice from a Medicare carrier on duly assigned claims submitted by 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;

 

(b)Notifying the participating physician or supplier and the beneficiary of the payment determination;

 

(c)Paying the participating physician or supplier directly;

 

(d)Furnishing, at the time of enrollment, each enrollee with a card listing the policy name, number and a central mailing address to which notices from a Medicare carrier may be sent;

 

(e)Paying user fees for claim notices that are transmitted electronically or otherwise; and

 

(f)Providing to the Secretary, at least annually, a central mailing address to which all claims may be sent by Medicare carriers.

 

2211.2Compliance with the requirements set forth in subsection 2211.1 shall be certified on the Medicare supplement insurance experience reporting form.

 

source

Final Rulemaking published at 46 DCR 10175 (December 17, 1999); as amended by Final Rulemaking published at 50 DCR 4166 (May 30, 2003); as amended by Final Rulemaking published at 50 DCR 5882 (July 25, 2003); as amended by Final Rulemaking published at 53 DCR 2955(April 14, 2006).