Utah Admin. Code R590-146-13 - 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 Action of 1987, OBRA, 1987, Pub. L. No. 100-203, by:

(a) accepting a notice from a Medicare issuer on dually assigned claims submitted by a participating physician and supplier as a claim for benefits in place of any other claim form otherwise required and making a payment determination based on 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 enrollment, each enrollee 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, a central mailing address where each claim may be sent by an issuer.

(2) Compliance with the requirements in this section shall be certified on the Medicare supplement insurance experience reporting form.

Notes

Utah Admin. Code R590-146-13

Amended by Utah State Bulletin Number 2019-13, effective 6/7/2019 Adopted by Utah State Bulletin Number 2024-16, effective 8/7/2024