Iowa Code 510B.8C – Clean claims
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Terms Used In Iowa Code 510B.8C
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
510B.8C Clean claims.
After the date of receipt of a clean claim submitted by a pharmacy in a pharmacy network,
a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly except in the following circumstances:
1. The claim is found not to be a clean claim during the course of a routine audit.
2. The claim submission was fraudulent.
3. The claim submission was a duplicate submission of a claim for which the pharmacy had already received payment.
2022 Acts, ch 1113, §10, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts,
ch 1113, §16
After the date of receipt of a clean claim submitted by a pharmacy in a pharmacy network,
a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly except in the following circumstances:
1. The claim is found not to be a clean claim during the course of a routine audit.
2. The claim submission was fraudulent.
3. The claim submission was a duplicate submission of a claim for which the pharmacy had already received payment.
2022 Acts, ch 1113, §10, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts,
ch 1113, §16