(a)A contract between an insurer or the insurer's
intermediary and a pharmacy for prescription drug coverage
offered by the insurer or the insurer's intermediary shall
require the insurer or the insurer's intermediary to make
payment to the pharmacy for all clean claims submitted by a
pharmacy within the applicable number of calendar days after the
date that the clean claim is received. For purposes of this
section, a claim is considered to have been received:
(i)For claims submitted electronically, on the date
that the claim is submitted; or
(ii)For claims submitted in any manner other than
electronically, on the fifth day after the postmark date of the
claim or the date specified on the time stamp of the
transmission of the claim.
(b)For purposes of this section, a contract between a
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(a) A contract between an insurer or the insurer's
intermediary and a pharmacy for prescription drug coverage
offered by the insurer or the insurer's intermediary shall
require the insurer or the insurer's intermediary to make
payment to the pharmacy for all clean claims submitted by a
pharmacy within the applicable number of calendar days after the
date that the clean claim is received. For purposes of this
section, a claim is considered to have been received:
(i) For claims submitted electronically, on the date
that the claim is submitted; or
(ii) For claims submitted in any manner other than
electronically, on the fifth day after the postmark date of the
claim or the date specified on the time stamp of the
transmission of the claim.
(b) For purposes of this section, a contract between an
insurer or the insurer's intermediary and a pharmacy regarding
prescription drug coverage offered by an insurer or the
insurer's intermediary shall include any contract regarding
prescription drug coverage offered by the insurer or the
insurer's intermediary under which a pharmacy is legally
obligated, either directly or through an intermediary such as a
pharmacy benefit manager.
(c) If the insurer or the insurer's intermediary does not
make payment within the applicable number of calendar days after
a clean claim is received, or resubmitted under subsections (e)
and (f) of this section, the insurer or the insurer's
intermediary shall pay interest to the pharmacy at the rate of
eighteen percent (18%) per annum, billed weekly.
(d) A claim shall be considered a clean claim if the
insurer or the insurer's intermediary does not provide notice to
the pharmacy of any deficiency in the claim within ten (10) days
after an electronically submitted claim is received or within
fifteen (15) days after a claim that is submitted in any other
manner is received.
(e) If an insurer or the insurer's intermediary determines
that a claim submitted is not a clean claim, the insurer or the
insurer's intermediary shall notify the pharmacy of the
determination within ten (10) days of receiving an
electronically submitted claim or within fifteen (15) days of
receiving a claim that is submitted in any other manner. The
notice shall specify all defects in the claim and list all
information or documents necessary for the proper processing and
payment of the claim.
(f) A claim resubmitted to an insurer or the insurer's
intermediary with additional information pursuant to subsection
(e) of this section shall be considered to be a clean claim if
the insurer or the insurer's intermediary fails to provide
notice to the pharmacy of any defect in the claim within ten
(10) days of the date that additional information is received if
the claim is resubmitted electronically or within fifteen (15)
days of the date that additional information is received if the
claim is resubmitted in any other manner. A resubmitted claim
that is considered to be a clean claim under this subsection
shall be paid within the applicable number of calendar days
after the date that the resubmitted claim is received and, if
payment is not timely made, interest shall accrue as provided by
subsection (c) of this section.
(g) Payment of a clean claim under this section shall be
considered to have been made on the date that the payment is
transferred to the pharmacy provider account, or to the central
pay account of the pharmacy services administrative organization
that is directly contracted by the pharmacy, with respect to
claims paid electronically and on the date that the payment is
submitted to the postal service or common carrier for delivery
with respect to claims paid in any other manner.
(h) No insurer shall directly or indirectly charge a
pharmacy or hold the pharmacy responsible for fees associated
with claims payment.