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2020 Maryland Statutes
Insurance
Title 15 - Health Insurance
Subtitle 16 - Pharmacy Benefits Managers
Part V - Contracts With Pharmacies and Pharmacists; Audits
Section 15-1631 - Retroactive Denial or Modification of Reimbursement for Approved Claim
Universal Citation: MD. Insurance Code Ann. § 15-1631 (2020)
Except for an overpayment as defined in § 15–1629(h) of this subtitle, if a claim has been approved by a pharmacy benefits manager through adjudication, the pharmacy benefits manager may not retroactively deny or modify reimbursement to a pharmacy or pharmacist for the approved claim unless:
(1) the claim was fraudulent;
(2) the pharmacy or pharmacist had been reimbursed for the claim previously; or
(3) the services reimbursed were not rendered by the pharmacy or pharmacist.
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