S.D. Admin. R. 20:06:13:49

Current through Register Vol. 51, page 67, December 16, 2024

Section 20:06:13:49 - Requirements for claims payment

An issuer shall comply with § 1882(c)(3) of the Social Security Act {as enacted by § 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203 }, 42 U.S.C. § 1395 etseq, as in effect on July 1, 1992, 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 the participating physician or supplier and the beneficiary of the payment determination;

(3) Paying the participating physicians or supplier directly;

(4) Furnishing each enrollee at the time of enrollment with a card listing the policy name and 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 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.

The issuer shall certify compliance with the requirements set forth in this section on the Medicare supplement insurance experience reporting form.

S.D. Admin. R. 20:06:13:49

15 SDR 143, effective 3/29/1989; 17 SDR 58, effective 10/29/1990; 18 SDR 225, effective 7/17/1992.

General Authority: SDCL 58-4-1, 58-17A-2.

Law Implemented: SDCL 58-17A-2.