™Your Policy Risk Impact Agent
40 chapters · 235 sections in this title.
N.D.C.C. § 19-03.6-01 Definitions
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For the purposes of this chapter: 1. "Entity" means a managed care company, an insurance company, a third-party payer, a pharmacy benefits manager, or any other organization that represents an insurance company, a third-party payer, or a pharmacy benefits manager. 2. "Insurance c…
N.D.C.C. § 19-03.6-02 Pharmacy benefits manager audit - Rules
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1. An entity conducting an audit of a pharmacy shall: a. If conducting an onsite audit, give the pharmacy a written notice at least fourteen business days before conducting an initial audit. b. If the audit involves clinical or professional judgment, ensure the audit is conducted…
N.D.C.C. § 19-03.6-03 Audit reports - Disclosure - Distribution of recouped funds - Review of auditor
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1. A preliminary audit report must be delivered to the pharmacy within one hundred twenty days after the conclusion of the audit. 2. A pharmacy must be allowed at least sixty days following receipt of the preliminary audit to provide documentation to address any discrepancy found…
N.D.C.C. § 19-03.6-04 Applicability
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1. This chapter applies to claims adjudicated after July 31, 2011. 2. This chapter does not apply to any audit, review, or investigation that is initiated based upon alleged fraud, willful misrepresentation, or abuse, including: a. Insurance fraud as defined in chapter 26.1-02.1.…
