Section Ins 2704.05 - Claims Processing(a) Every health carrier that provides prescription benefits as a covered benefit under a health benefit plan shall ensure that prescription benefit claims are adjusted and paid in accordance with the requirements of Ins 1001 and RSA 420-J:8-a.(b) Any health carrier or PBM shall require all participating pharmacies to charge any covered person the lesser of: (1) The pharmacy's usual and customary price for filling the prescription; or(2) The contracted copayment.(c) The health carrier or PBM shall not be in violation of this section when the conditions set forth in RSA 420-J:8-a, IV exist or the claim has been submitted fraudulently or with inaccurate or misrepresented information.N.H. Admin. Code § Ins 2704.05
Derived From Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12121, Effective 2/24/2017, Expires 2/24/2027.Amended by Volume XL Number 28, Filed July 9, 2020, Proposed by #13059, Effective 6/29/2020, Expires 6/29/2030.