20-3321. Definitions In this chapter, unless the context otherwise requires: 1. " Auditing entity" means any person, company, group or plan working on behalf of or pursuant to a contract with an insurer or pharmacy benefits manager for the purposes of auditing pharmacy drug claims adjudicated by pharmacies. 2. " Clerical errors" means a minor […]
20-3322. Audit procedures; interest prohibition A. The following procedures apply to an audit conducted by an auditing entity: 1. When conducting an in-pharmacy audit an auditing entity shall: (a) Give a pharmacy at least fourteen days’ written notice. (b) Not conduct an audit during the first five days of the month unless the pharmacy otherwise […]
20-3323. Audit reports A. The auditing entity must deliver a preliminary audit report to the pharmacy within sixty days after the conclusion of the audit. B. A pharmacy is allowed at least thirty days after receipt of the preliminary audit to provide documentation to address any discrepancy found in the audit. C. Each auditing entity […]
20-3324. Applicability A. Notwithstanding any other law, this article applies only to audits conducted of pharmacies located in this state. B. This article does not apply to claims reviews that are initiated within three business days after transmission of a claim in which no chargeback or recoupment is demanded. C. This article does not apply […]
