{"data":{"id":"us-va/14vac5-170-110","jurisdiction":"us-va","citation":"14VAC5-170-110","heading":"Standards for claims payment","body":"A. 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, Public Law No. 100-203, 101 Stat. 1330 (December 22, 1991)) by:\n\n1. 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;\n\n2. Notifying the participating physician or supplier and the beneficiary of the payment determination;\n\n3. Paying the participating physician or supplier directly;\n\n4. 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;\n\n5. Paying user fees for claim notices that are transmitted electronically or otherwise; and\n\n6. Providing to the Secretary, at least annually, a central mailing address to which all claims may be sent by Medicare carriers.\n\nB. Compliance with the requirements set forth in subsection A above shall be certified on the Medicare supplement insurance experience reporting form.","path":["Title 14. Insurance","Agency 5. State Corporation Commission, Bureau of Insurance","Chapter 170. Rules Governing Minimum Standards for Medicare Supplement Policies"],"source_url":"https://law.lis.virginia.gov/admincode/title14/agency5/chapter170/section110/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:51:52Z","sha256":"31c5d59b94705fb48b2a3d107dcfaf12ceb38055fd67e886923487ef5383e721","source_id":"us-va-vac","stale":false,"prev":"us-va/14vac5-170-105","next":"us-va/14vac5-170-120"},"notice":"GroundRules: Original legal text. Not legal advice."}