New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 25 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS
Section 13.10.25.19 - STANDARDS FOR CLAIMS PAYMENT
Universal Citation: 13 NM Admin Code 13.10.25.19
Current through Register Vol. 35, No. 18, September 24, 2024
A. An issuer shall comply with section 1882(c)(3) of the Social Security Act ( 42 U.S.C. § 1395ss(c)(3), 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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