NAC687B.286. Compliance with certain provisions of Social Security Act regarding notice and payment of claims.

     1. An issuer shall comply with the provisions of section 1882(c)(3) of the Social Security Act, 42 U.S.C. §§ 1395 et seq., as enacted by section 4081(b)(2)(c) of the Omnibus Budget Reconciliation Act of 1987, Public Law No. 100-203, by:

     (a) Accepting a notice from a Medicare carrier on an assigned claim submitted by a participating physician or supplier as a claim for benefits in lieu of any other claim form otherwise required;

     (b) Making a determination for payment on the basis of the information contained in that notice;

     (c) Notifying the participating physician or supplier and the beneficiary of the determination for payment;

     (d) Paying the participating physician or supplier directly;

     (e) Furnishing each enrollee, at the time of enrollment, with a card listing the name and number of the policy and a central mailing address to which notices from a Medicare carrier may be sent;

     (f) Paying the user fees for claim notices that are transmitted electronically or otherwise; and

     (g) 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 requirements set forth in subsection 1 must be certified on the form for reporting experience incurred for policies to supplement Medicare and certificates which is prescribed by the Commissioner.

     3. The provisions of this section apply to an issuer of a policy to supplement Medicare or a certificate which is delivered or issued for delivery in this State, regardless of the date the policy or certificate was delivered or issued for delivery.

     (Added to NAC by Comm’r of Insurance, 7-16-92, eff. 7-30-92)