§ 1358.13. — 1358.13. (Amended by Stats. 2009, Ch. 10, Sec. 9.)

California § 1358.13.

• Jurisdiction: California
• Code HSC: Health and Safety Code - HSC
• Div. 2.: DIVISION 2. LICENSING PROVISIONS
• Ch. 2.2.: CHAPTER 2.2. Health Care Service Plans
• Art. 3.5.: ARTICLE 3.5. Additional Requirements for Medicare Supplement Contracts

Text

(a)
An issuer shall comply with Section 1882(c)(3) of the federal Social Security Act (as enacted by Section 4081(b)(2)(C) of the federal Omnibus Budget Reconciliation Act of 1987 (OBRA), Public Law 100-203) by doing all of the following:
(1)
Accepting a notice from a Medicare Administrative Contractor, formerly known as a fiscal intermediary or 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 physician or supplier directly.
(4)
Furnishing, at the time of enrollment, each enrollee with a card listing the contract name, number, and a central mailing address to which notices respecting coverage from a Medicare Administrative Contractor may be sent.
(5)
Paying user fees established under Section 1395u(h)(3)(B) of Title 42 of the United States Code, for claim notices that are transmitted electronically or otherwise.
(6)
Providing to the secretary, at least annually, a central mailing address to which all claims may be sent by Medicare Administrative Contractors.
(b)
Compliance with the requirements set forth in subdivision (a) shall be certified on the Medicare supplement insurance experience reporting form provided by the director.

Legislative History

Amended by Stats. 2009, Ch. 10, Sec. 9. Effective July 2, 2009.