(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.
KEY: insurance
Date of Last Change: September 29, 2025
Notice of Continuation: April 1, 2022
Authorizing, and Implemented or Interpreted Law: 31A-22-620