N.M. Admin. Code § 13.10.25.19

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.25.19 - STANDARDS FOR CLAIMS PAYMENT

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.

N.M. Admin. Code § 13.10.25.19

13.10.25.19 NMAC - N, 08/31/09, Adopted by New Mexico Register, Volume XXIX, Issue 24, December 27, 2018, eff. 1/1/2019