Florida Regulations 69O-156.010: Standards for Claims Payment
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(1) An issuer shall 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 (OBRA) 1987, Pub. L. No. 100-203) 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 69O-156.010(1), F.A.C., shall be certified on the Medicare supplement insurance experience reporting form.
Rulemaking Authority 624.308, 627.674 FS. Law Implemented 624.307(1), 627.674, 627.6746 FS. History-New 9-4-89, Formerly 4-51.015, Amended 1-1-92, Formerly 4-156.010.
Terms Used In Florida Regulations 69O-156.010
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- User fees: Fees charged to users of goods or services provided by the government. In levying or authorizing these fees, the legislature determines whether the revenue should go into the treasury or should be available to the agency providing the goods or services.
(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 69O-156.010(1), F.A.C., shall be certified on the Medicare supplement insurance experience reporting form.
Rulemaking Authority 624.308, 627.674 FS. Law Implemented 624.307(1), 627.674, 627.6746 FS. History-New 9-4-89, Formerly 4-51.015, Amended 1-1-92, Formerly 4-156.010.