6.6.515 STANDARDS FOR CLAIMS PAYMENT
(1) 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) , 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 form otherwise required 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 that are transmitted electronically or otherwise. Any cost may not be passed on to the insured as a separate distinguishable charge and the charge may not be separated from the premium; and
(f) Providing to the secretary of health and human services, at least annually, a central mailing address to which all claims may be sent by medicare carriers.
(2) Compliance with the above requirements must be certified on the medicare supplement insurance experience reporting form.
History: 33-1-313 and 33-22-904, MCA; IMP, 33-15-303 and 33-22-901 through 33-22-924, MCA; NEW, 1990 MAR p. 1688, Eff. 9/1/90; AMD, 1993 MAR p. 1487, Eff. 7/16/93; AMD, 1996 MAR p. 1637, Eff. 6/21/96.