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N.C. Gen. Stat. § 58-50-420

Mandatory appeals process

Known as the North Carolina Small Employer Group Health Coverage Reform Act

The act spans §§ 58-50-1 to 58-50-94 (62 sections).

2011-375, s. 1; recodified from N.C

(a) Each auditing entity shall establish an appeals process under which a pharmacy may appeal an unfavorable preliminary audit report to the auditing entity.

(b) If, following the appeal, the auditing entity finds that an unfavorable audit report or any portion of the unfavorable audit report is unsubstantiated, then the auditing entity shall dismiss the unsubstantiated portion of the audit report without any further proceedings.

(c) Each auditing entity shall provide a copy, if required under contractual terms, of the audit findings to the responsible party or the insurer offering a health benefit plan after completion of any appeals process.

Official source: North Carolina General Assembly. Reproduced from public-domain North Carolina statutes; confirm against the official source for the current text. Not legal advice.