Bill Summary for H 644 (2011-2012)

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Summary date: 

Apr 5 2011
S.L. 2011-375

Bill Information:

View NCGA Bill Details2011-2012 Session
House Bill 644 (Public) Filed Tuesday, April 5, 2011
TO ESTABLISH PHARMACY AUDIT RIGHTS AND TO ESTABLISH STANDARDS FOR RECOUPMENT OF CLAIMS.
Intro. by Murry.

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Bill summary

Enacts new Article 4C of GS Chapter 90 to specify rights of pharmacies in connection with audits of their records by managed care companies, insurance companies, third-party payers, and others responsible for payment of health care services. Rights include 30 days advance notice of an audit, a requirement that audits involving clinical or professional judgment be only by licensed North Carolina pharmacists, limitations on the scheduling and scope of the audits, rights to have access to records from prescribers to validate prescriptions, prohibitions against deeming certain kinds of discrepancies as fraudulent, and requirements for dismissal of audits under certain conditions. Requires establishment of an appeals process by the entity conducting the audit. Prohibits recoupment of disputed funds prior to final internal disposition of an audit including exhaustion of appeal rights, and restricts the amount of the recoupment. Effective October 1, 2011.