Prohibit Health Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies

Last updated: Mar 10, 2020

Details about this bill
Category: Pharmacy Related
Status: In Committee
Sponsor: Senator Nate Libby, Senate 21 - Androscoggin County
Session: 129
Bill #: LD 1928



UPDATE: This bill received a divided report from committee.


This bill prohibits a health insurance carrier from retroactively reducing payment on a properly submitted claim by a pharmacy provider. The bill also prohibits a carrier from charging a pharmacy provider or holding a pharmacy provider responsible for any fee related to a claim that is not apparent at the time the carrier processes the claim, that is not reported on the remittance advice or after the initial claim is adjudicated by the carrier.