Connecticut Administrative Code
Title 38a - Insurance Department
495a - Medicare Supplement Insurance
Section 38a-495a-9 - Standards for claims payment
Universal Citation: CT Reg of State Agencies 38a-495a-9
Current through March 14, 2024
(a) An 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 (OBRA) 1987, Pub. L. No. 100-203 ) by:
(1) Accepting a notice from a Medicare
carrier on dually 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;
(2)
Notifying the participating physician or supplier and the beneficiary of the
payment determination;
(3) Paying
the participating physician or supplier directly;
(4) 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;
(5) Paying user fees for claim notices that
are transmitted electronically or otherwise; and
(6) Providing to the secretary, at least
annually, a central mailing address to which all claims may be sent by Medicare
carriers.
(b) Compliance with the requirements set forth in subsection (a) of this section shall be certified on the Medicare supplement insurance experience reporting form.
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