(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 and by certifying compliance on the Medicare supplement insurance experience reporting form:
(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 determinati
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(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 and by certifying compliance on the Medicare supplement insurance experience reporting form:
(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 policy name, number, and a central mailing address to which notices from Medicare Administrative Contractors may be sent.
(5)
Paying user fees 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.
(7)
File, by June 30 of each year, with the commissioner a list of its Medicare supplement policies and certificates offered or issued or in force in California as of the end of the previous year.
(A)
The list shall identify the issuer by name and address, shall identify each type of form it offers by name and form number, and shall differentiate between forms approved in the previous calendar year and those approved before the previous calendar year.
(B)
The list shall identify all of the following:
(i)
Forms issued and in force but no longer offered in California.
(ii)
Forms that, for any reason, were not filed and approved by the commissioner.
(iii)
Forms for which the commissioner’s approval was withdrawn within the previous calendar year.
(iv)
The number of forms issued in California in the previous calendar year, and the number of forms in force in California on December 31 of the previous calendar year.
(b)
(1)
Compliance with the requirements set forth in subdivision (a) shall be certified on the Medicare supplement insurance experience reporting form provided by the commissioner.
(2)
The commissioner shall, by September 1 of each year, provide the secretary with a list identifying each issuer by name and address and provide the information requested in this section.
(c)
No issuer that administers Medicare coverage and federal employee programs may require that more than one form be submitted per claim in order to receive payment or reimbursement under any or all of those policies or programs.