Section 760 IAC 5-3-9 - Internal appeal processAuthority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 9.
(a) An auditor must establish an internal appeal process under which a pharmacy or pharmacist may appeal a disputed claim in a preliminary audit report.(b) Under the internal appeals process, an auditor must allow a pharmacy or pharmacist to request an internal appeal within thirty (30) calendar days after receipt of a preliminary audit report, with reasonable extensions allowed.(c) An auditor must include in its preliminary audit report a written explanation of the internal appeals process, including the name, address, and telephone number of the person or entity to whom an internal appeal should be addressed.(d) The decision of the auditor on an appeal of a disputed claim in a preliminary audit report by a pharmacy or pharmacist must be reflected in the final audit report.(e) An auditor must deliver a final audit report to a pharmacy or pharmacist not later than one hundred twenty (120) calendar days after a final appeal determination is made. The final report must include a final accounting of all monies to be recovered or returned by the pharmacy benefit manager.Department of Insurance; 760 IAC 5-3-9; filed 2/23/2023, 9:48 a.m.: 20230322-IR-760220287FRA