Current through September 2, 2024
Section 18.04.10.046 - STANDARDS FOR CLAIMS PAYMENT01.Compliance. An issuer will 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: a. 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 needed 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; andf. Providing to the Secretary, at least annually, a central mailing address to which all claims may be sent by Medicare carriers.02.Certification. Compliance with the requirements set forth in Subsection 046.01 is certified on the Medicare supplement insurance experience reporting form.Idaho Admin. Code r. 18.04.10.046