Section 3.28.466. Standards for claim payment.

	(a)  An issuer shall comply with 42 U.S.C. 1395ss(c) (sec. 1882(c)(3) of the Social Security Act, as enacted by sec. 4081(b)(2)(C) of the Ominbus 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 of the payment determination  
			(A) the participating physician or supplier; and  
			(B) the beneficiary;  
		(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 at least annually to the secretary a central mailing address to which all claims may be sent by medicare carriers.  
	(b)  The issuer shall certify compliance with the requirements of (a) of this section on the medicare supplement insurance experience reporting form.  

Authorities

21.06.090;21.42.130;21.96.060;01.05.031;21.89.060;44.62.125

Notes

Authority

AS 21.06.090 AS 21.42.130 AS 21.96.060 Editor's note: Before Register 150, July 1999, the substance of 3 AAC 28.466 appeared as 3 AAC 28.458. In 2010 the revisor of statutes, acting under AS 01.05.031, renumbered former AS 21.89.060 as AS 21.96.060. As of Register 196 (January 2011), the regulations attorney made a conforming technical revision under AS 44.62.125(b)(6), to the authority citation that follows 3 AAC 28.466, so that the citation to former AS 21.89.060 now refers to the renumbered statute, AS 21.96.060.

History

Eff. 4/21/99, Register 150

References

3.28.466;3.28.458