§ 15-1628 Required disclosures by pharmacy benefits manager; filing requirements for contract or amendment to contract
§ 15-1628.1 Maximum allowable cost pricing between pharmacy benefits manager and contracted pharmacy
§ 15-1628.2 Disputes regarding cost pricing and reimbursement
§ 15-1628.3 Fee or performance-based reimbursement related to claim adjudication
§ 15-1629 Audits by pharmacy benefits manager
§ 15-1629 v2 Audits by pharmacy benefits manager
§ 15-1630 Internal review process
§ 15-1631 Retroactive denial or modification of reimbursement for approved claim

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Terms Used In Maryland Code > INSURANCE > Title 15 > Subtitle 16 > Part V - Contracts With Pharmacies and Pharmacists; Audits

  • Adult: means an individual at least 18 years old. See
  • Allegation: something that someone says happened.
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Arrest: Taking physical custody of a person by lawful authority.
  • assault: means assault in any degree unless a specific degree of assault is specified. See
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Codicil: An addition, change, or supplement to a will executed with the same formalities required for the will itself.
  • Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • County: means a county of the State or Baltimore City. See
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Decedent: A deceased person.
  • Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Dismissal: The dropping of a case by the judge without further consideration or hearing. Source:
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Finance charge: The total cost of credit a customer must pay on a consumer loan, including interest. The Truth in Lending Act requires disclosure of the finance charge. Source: OCC
  • Fraud: Intentional deception resulting in injury to another.
  • including: means includes or including by way of illustration and not by way of limitation. See
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • minor: means an individual under the age of 18 years. See
  • Oath: A promise to tell the truth.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Person: includes an individual, receiver, trustee, guardian, personal representative, fiduciary, representative of any kind, corporation, partnership, business trust, statutory trust, limited liability company, firm, association, or other nongovernmental entity. See
  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
  • Quorum: The number of legislators that must be present to do business.
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • state: means :

    (1) a state, possession, territory, or commonwealth of the United States; or

    (2) the District of Columbia. See
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • Uphold: The decision of an appellate court not to reverse a lower court decision.