An Act To Prohibit Health Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies
Sec. 1. 24-A MRSA §4317, sub-§2, as enacted by PL 2009, c. 519, §1 and affected by §2, is amended to read:
(1) "Applicable number of calendar days" means:
(a) With respect to claims submitted electronically, 21 days; and
(b) With respect to claims submitted otherwise, 30 days.
(2) "Clean claim" means a claim that has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this section.
(1) With respect to claims submitted electronically, on the date on which the claim is transferred; and
(2) With respect to claims submitted otherwise, on the 5th day after the postmark date of the claim or the date specified in the time stamp of the transmission of the claim.
(1) That is not apparent at the time the carrier processes the claim;
(2) That is not reported on the remittance advice of a claim adjudicated by the carrier; or
(3) After the initial claim is adjudicated by the carrier.
For purposes of this subsection, a contract entered into by a carrier with a pharmacy provider with respect to a prescription drug plan offered by a carrier includes any contract with respect to a prescription drug plan offered by the carrier under which a pharmacy provider is legally obligated, either directly or through an intermediary.