Md. Code, Ins. § 15-1631

Current with changes from the 2024 Legislative Session

Section 15-1631 - Retroactive denial or modification of reimbursement for approved claim

Except for an overpayment as defined in § 15-1629(h) of this subtitle, if a claim has been approved by a pharmacy benefits manager through adjudication, the pharmacy benefits manager may not retroactively deny or modify reimbursement to a pharmacy or pharmacist for the approved claim unless:

(1) the claim was fraudulent;

(2) the pharmacy or pharmacist had been reimbursed for the claim previously; or

(3) the services reimbursed were not rendered by the pharmacy or pharmacist.

Md. Code, IN § 15-1631

Amended by 2019 Md. Laws, Ch. 400,Sec. 1, eff. 5/13/2019.