There is a newer version of this Section
2020 Maryland Statutes
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.
Disclaimer: These codes may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.