(1) As used in this subchapter:(1) (A) “Audit” means a financial audit, performance audit, information technology audit, review, report of agreed-upon procedures, compilation, examination, investigation, prepayment audit, or other report or procedure regarding the practice of pharmacy, including without limitation an audit of a pharmacist or pharmacy for pharmacist services.(B) “Audit” includes a prescription validation request or prescription validation review if:(i) The prescription validation request or review requires the pharmacist or pharmacy to submit additional information to the pharmacy benefits manager after a claim has been processed successfully at the point of sale; or(ii) There is any attempted or required recoupment of funds or denial of payment to the pharmacy or pharmacist after a successful electronically billed or submitted claim based on a prescription validation request or prescription validation review;(2) “Prepayment audit” means an audit or review that occurs shortly after the sale and dispensing of a drug to a patient and before the reimbursement payment to the pharmacy, regardless of the label given to the audit or review or the method used to communicate the prepayment audit to the pharmacy;(3) “Prescription validation request or review” means information provided to a pharmacy or pharmacist to help educate, clarify, or verify the accuracy and validity of prescription claim submissions; and(4) “Randomly selected” means selected without method or conscious decision.
(1) (A) “Audit” means a financial audit, performance audit, information technology audit, review, report of agreed-upon procedures, compilation, examination, investigation, prepayment audit, or other report or procedure regarding the practice of pharmacy, including without limitation an audit of a pharmacist or pharmacy for pharmacist services.(B) “Audit” includes a prescription validation request or prescription validation review if:(i) The prescription validation request or review requires the pharmacist or pharmacy to submit additional information to the pharmacy benefits manager after a claim has been processed successfully at the point of sale; or(ii) There is any attempted or required recoupment of funds or denial of payment to the pharmacy or pharmacist after a successful electronically billed or submitted claim based on a prescription validation request or prescription validation review;
(A) “Audit” means a financial audit, performance audit, information technology audit, review, report of agreed-upon procedures, compilation, examination, investigation, prepayment audit, or other report or procedure regarding the practice of pharmacy, including without limitation an audit of a pharmacist or pharmacy for pharmacist services.
(B) “Audit” includes a prescription validation request or prescription validation review if:(i) The prescription validation request or review requires the pharmacist or pharmacy to submit additional information to the pharmacy benefits manager after a claim has been processed successfully at the point of sale; or(ii) There is any attempted or required recoupment of funds or denial of payment to the pharmacy or pharmacist after a successful electronically billed or submitted claim based on a prescription validation request or prescription validation review;
(i) The prescription validation request or review requires the pharmacist or pharmacy to submit additional information to the pharmacy benefits manager after a claim has been processed successfully at the point of sale; or
(ii) There is any attempted or required recoupment of funds or denial of payment to the pharmacy or pharmacist after a successful electronically billed or submitted claim based on a prescription validation request or prescription validation review;
(2) “Prepayment audit” means an audit or review that occurs shortly after the sale and dispensing of a drug to a patient and before the reimbursement payment to the pharmacy, regardless of the label given to the audit or review or the method used to communicate the prepayment audit to the pharmacy;
(3) “Prescription validation request or review” means information provided to a pharmacy or pharmacist to help educate, clarify, or verify the accuracy and validity of prescription claim submissions; and
(4) “Randomly selected” means selected without method or conscious decision.