2006 Ohio Revised Code - 5110.17. Payment for complete and timely claim.

§ 5110.17. Payment for complete and timely claim.
 

(A)  In accordance with rules adopted under section 5110.35 of the Revised Code and subject to section 5110.19 of the Revised Code, the department of job and family services shall pay a participating terminal distributor or the Ohio's best Rx program administrator for complete and timely claims for drugs included in the program that are covered by a rebate agreement entered into under section 5110.21 of the Revised Code. The payment for a complete and timely claim shall be made by a date that is not later than two weeks after the claim is received by the department. 

(B)  Subject to division (D) of this section, the amount to be paid for a claim shall be determined as follows: 

(1) Multiply the rebate amount for the national drug code number for the drug for which the claim is made, as agreed to under division (B)(4)(a) of section 5110.21 of the Revised Code or computed under division (B) of section 5110.27 of the Revised Code, as applicable, by the number of units of the drug dispensed to the Ohio's best Rx program participant; 

(2) If an administrative fee was charged, for each transaction in which a quantity of the drug was dispensed, subtract from the amount computed under division (B)(1) of this section the administrative fee amount specified in rules adopted under section 5110.35 of the Revised Code. 

(C)  The department may combine claims from a participating terminal distributor or the administrator to make aggregate payments under this section to the distributor or administrator. 

(D)  If the total of the amounts computed under division (B) of this section for any period for which payments are due is a negative number, the terminal distributor or administrator has been overpaid for claims submitted under section 5110.16 of the Revised Code. When there is an overpayment, the department shall reduce future payments to the terminal distributor or administrator under this section or collect an amount from the terminal distributor or administrator sufficient to reimburse the department for the overpayment. 
 

HISTORY: 150 v H 311, § 1, eff. 12-18-03.