38.2-3407.9:03 - Payment of clean claims to administrators of pharmacy benefits - Virginia Statutes

§ 38.2-3407.9:03. Payment of clean claims to administrators of pharmacybenefits.

A. As used in this section, "clean claim," "carrier," and "providercontract," shall have the meanings set forth in subsection A of §38.2-3407.15.

B. Any contract between a carrier and its pharmacy benefits administrator ora carrier and a participating pharmacy, or its contracting agent, thatrequires claims be submitted electronically shall require that payment bemade electronically to the participating provider or its designee for cleanclaims, as defined in subsection A of § 38.2-3407.15, submittedelectronically. An electronic claim must be submitted in the form required bythe carrier and in compliance with 45 CFR Part 142, as amended, provided thatthe participating provider or designee agrees to accept claims details forsuch payments electronically, in compliance with 45 CFR Part 142, as amended,and provides accurate electronic funds transfer information to the carrier.

C. This section shall apply with respect to contracts between a carrier andits pharmacy benefits administrator or a carrier and a pharmacy, or itscontracting agent, that are entered into, amended, extended, or renewed on orafter January 1, 2009.

(2008, c. 104.)