Iowa Admin. Code r. 191-59.3 - Timely payment of pharmacy claims
(1) All benefits
payable under a pharmacy benefits management plan shall be paid as soon as
feasible but within 20 days after receipt of a clean claim when the claim is
submitted electronically and shall be paid within 30 days after receipt of a
clean claim when the claim is submitted in paper format.
(2) A payment to the pharmacy for a clean
claim is considered to be overdue and not timely if not paid within 20 or 30
days, whichever is applicable. If a clean claim is not timely paid , the
pharmacy benefits manager must pay the pharmacy interest at the rate of 10
percent per annum commencing the day after any claim payment or portion thereof
was due until the claim is finally settled or adjudicated in full.
(3) A pharmacy benefits manager may
demonstrate the date a claim is paid by a mail record or a bank
statement.
(4) Pursuant to Iowa Code
section 510B.8C, a pharmacy benefits manager shall not retroactively reduce
reimbursement, through adjustment or reconciliation or any other means, of a
clean claim paid to pharmacies.
Notes
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(1) All benefits payable under a pharmacy benefits management plan shall be paid as soon as feasible but within 20 days after receipt of a clean claim when the claim is submitted electronically and shall be paid within 30 days after receipt of a clean claim when the claim is submitted in paper format.
(2) A payment to the pharmacy for a clean claim is considered to be overdue and not timely if not paid within 20 or 30 days, whichever is applicable. If a clean claim is not timely paid , the pharmacy benefits manager must pay the pharmacy interest at the rate of 10 percent per annum commencing the day after any claim payment or portion thereof was due until the claim is finally settled or adjudicated in full.
(3) A pharmacy benefits manager may demonstrate the date a claim is paid by a mail record or a bank statement.
(4) Pursuant to Iowa Code section 510B.8C, a pharmacy benefits manager shall not retroactively reduce reimbursement, through adjustment or reconciliation or any other means, of a clean claim paid to pharmacies.