Sec. 21.27.955. Definitions.
In AS 21.27.901 – 21.27.955, (1) “audit” means an official examination and verification of accounts and records; (2) “claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device; (3) “extrapolation” means the practice […]
Sec. 21.27.990. Definitions.
In this chapter, (1) “accredited state” means a state in which the insurance department or regulatory agency of that state has qualified as meeting the minimum financial regulatory standards adopted and established by the National Association of Insurance Commissioners; (2) “affiliate” or “affiliated” has the meaning given in AS 21.22.200; (3) “appointment” means an act […]
Sec. 21.27.940. Pharmacy audits; restrictions.
The requirements of AS 21.27.901 – 21.27.955 do not apply to an audit (1) in which suspected fraudulent activity or other intentional or wilful misrepresentation is evidenced by a physical review, a review of claims data, a statement, or another investigative method; or (2) of claims paid for under the medical assistance program under AS […]
Sec. 21.27.945. Drug pricing list; procedural requirements.
(a) A pharmacy benefits manager shall (1) make available to each network pharmacy at the beginning of the term of the network pharmacy’s contract, and upon renewal of the contract, the methodology and sources used to determine the drug pricing list; (2) provide a telephone number at which a network pharmacy may contact an employee […]
Sec. 21.27.950. Multi-source generic drug appeal.
(a) A pharmacy benefits manager shall establish a process by which a network pharmacy, or a network pharmacy’s contracting agent, may appeal the reimbursement for a multi-source generic drug. A pharmacy benefits manager shall resolve an appeal from a network pharmacy within 10 calendar days after the network pharmacy or the contracting agent submits the […]
Sec. 21.27.830. Independent adjuster qualifications.
In addition to the general qualifications under AS 21.27.020, to qualify for issuance or renewal of an independent adjuster license, an applicant or licensee shall (1) have at least six months active working experience within the previous two calendar years as either an independent adjuster trainee, an insurance producer, a managing general agent, a reinsurance […]
Sec. 21.27.840. Trainee independent adjusters.
(a) An individual resident who does not have the experience with reference to the handling of loss claims but who otherwise meets the requirements of AS 21.27.830, may be employed by a licensed independent adjuster as a trainee independent adjuster, subject to the provisions of this section. (b) Before the individual may handle loss claims, […]
Sec. 21.27.850. Insurance producer, managing general agent, surplus lines broker, reinsurance intermediary broker, and reinsurance intermediary manager as independent adjuster.
Without being required by this chapter to be licensed also as an independent adjuster (1) a licensed insurance producer and a licensed managing general agent, incidental to acting as an insurance producer, may act as an adjuster and investigate, adjust, and report upon claims on behalf of and as authorized by an admitted insurer that […]
Sec. 21.27.860. Unlicensed nonresident adjusters.
(a) A nonresident independent adjuster not licensed by this state who is licensed by and in good standing with its resident state may act as an adjuster and adjust a single loss in this state during a calendar year, or may act as an adjuster and adjust losses arising out of a catastrophe as declared […]
Sec. 21.27.870. Independent adjuster records.
In addition to any other records requirements under this chapter, an independent adjuster shall maintain in organized form a complete record of each investigation or adjustment undertaken or consummated, and a statement of the fee, commission, or other compensation received or to be received by the adjuster on account of the investigation or adjustment.