Public-domain · open source
OpenJurist

Iowa Code § 510B.8C

Clean claims

2022 Acts, ch 1113, §10, 16, 23

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.

Official source: Iowa Legislature. Reproduced from public-domain Iowa statutes; confirm against the official source for the current text. Not legal advice.