Standards for claims payment

1. An issuer must comply with section 1882(c)(3) of the Social Security Act [as enacted by section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203; 101 Stat. 1330; 42 U.S.C. 1395ss(c)(3))] by: a. 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; 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 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; e. Paying user fees for claim notices that are transmitted electronically or otherwise; and f. 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. 2. Compliance with the requirements set forth in subsection 1 must be certified on the Medicare supplement insurance experience reporting form.