Iowa Admin. Code r. 191-37.22

Current through Register Vol. 46, No. 20, April 3, 2024

Rule 191-37.22 - Standards for claims payment

(1)Compliance with OBRA. 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:

a. Accepting a notice from an issuer on dually assigned claims submitted by participating providers 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;

b. Notifying the participating provider or supplier and the beneficiary of the payment determination;

c. Paying the participating provider or supplier directly;

d. Furnishing, at the time of enrollment, each covered individual with a card listing the policy name, number and a central mailing address to which notices from an issuer may be sent;

e. Paying user fees for claim notices that are transmitted electronically or otherwise; and

f. Providing to the Secretary, at least annually, the issuer's central mailing address to which all claims may be sent by other issuers.

(2)Certification of compliance with OBRA. Compliance with the requirements set forth in 37.22(1) shall be certified on the Medicare supplement insurance experience reporting form.

Iowa Admin. Code r. 191-37.22

ARC 7964B, lAB 7/15/09, effective 8/19/09

Amended by IAB April 10, 2019/Volume XLI, Number 21, effective 5/15/2019