Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies
Section 31.10.05.08 - Standards for Claims Payment
Universal Citation: MD Code Reg 31.10.05.08
Current through Register Vol. 51, No. 19, September 20, 2024
A. Each insurer providing Medicare supplement policies or contracts shall comply with all provisions of § 4081 of the Omnibus Budget Reconciliation Act of 1987 ( P.L. 100-203), and with applicable rules and regulations issued under the Act by the Secretary of the federal Department of Health and Human Services. Some of the provisions of the Act require each insurer issuing Medicare supplement policies to:
(1) Agree to accept claims notices as claims for benefits under the policies;
(2) Agree to make payment determination based on the information provided in the notices;
(3) Provide notices to participating providers and suppliers and to the beneficiaries concerning the payment determinations;
(4) Provide payment directly to participating providers and suppliers;
(5) Provide Medicare beneficiaries with the name and address of Medicare contracting carriers to which notices should be sent; and
(6) Agree to pay usual fees.
B. Each insurer shall certify on its Medicare supplement insurance experience reporting forms compliance with the requirements set forth in §A of this regulation.
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