Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 275 - Medicare Supplement Insurance
Section 031-275-13 - Standards for Claims Payment
Universal Citation: 02 ME Code Rules ยง 031-275-13
Current through 2024-13, March 27, 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
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 set forth in Subsection A above shall be certified on the Medicare supplement insurance experience reporting form.
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