§ 15-1630
227 words·~1 min read·
/md/insurance/15-1630A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–1630.
(a)This section applies only to a pharmacy benefits manager that provides pharmacy benefits management services on behalf of a carrier.
(b)A pharmacy benefits manager shall establish a reasonable internal review process for a pharmacy to request the review of a failure to pay the contractual reimbursement amount of a submitted claim.
(c)A pharmacy may request a pharmacy benefits manager to review a failure to pay the contractual reimbursement amount of a claim within 180 calendar days after the date the submitted claim was paid by the pharmacy benefits manager.
(d)The pharmacy benefits manager shall give written notice of its review decision within 90 calendar days after receipt of a request for review from a pharmacy under this section.
(e)If the pharmacy benefits manager determines through the internal review process established under subsection
(b)of this section that the pharmacy benefits manager underpaid a pharmacy, the pharmacy benefits manager shall pay any money due to the pharmacy within 30 working days after completion of the internal review process.
(f)This section may not be construed to limit the ability of a pharmacy and a pharmacy benefits manager to contractually agree that a pharmacy may have more than 180 calendar days to request an internal review of a failure of the pharmacy benefits manager to pay the contractual amount of a submitted claim.