Title 3 . Commerce, Community, and Economic Development

Chapter 28 . Miscellaneous

Section 466. Standards for claim payment

3 AAC 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.

History: Eff. 4/21/99, Register 150

Authority: AS 21.06.090

AS 21.42.130

AS 21.89.060

Editor's note: Before Register 150, July 1999, the substance of 3 AAC 28.466 appeared as 3 AAC 28.458.