(a) No program administrator shall deny payment for services to any pharmacy that may have resulted from the fraudulent or illegal use of an identification card by any person, unless the pharmacy has been notified that the card has been cancelled or discontinued and that the program administrator has been unsuccessful in attempting to regain possession of the card.
Terms Used In Tennessee Code 63-10-105
Person: means any individual, partnership, association, corporation and the state, its departments, agencies and employees, and the political subdivisions of Tennessee and their departments, agencies and employees, except the department of health and local health departments. See Tennessee Code 63-10-204
Pharmacist: means an individual health care provider licensed by the state, pursuant to parts 4-6 of this chapter, to practice the profession of pharmacy. See Tennessee Code 63-10-204
Pharmacy: means a location licensed by this state where drugs are compounded or dispensed under the supervision of a pharmacist, as defined in the rules of the board and where prescription orders are received or processed. See Tennessee Code 63-10-204
(b) No program administrator shall withhold any payments to any pharmacy beyond the time period specified in the payment schedule provisions of the agreement, except that individual claims for payment may be returned to the pharmacy for cause, such as incomplete or illegible information, and may then be resubmitted by the pharmacy to the program administrator after the appropriate corrections have been made.(c) No program administrator shall deny or withhold payment to any pharmacy for duplicate prescription refills or prescription refills that are dispensed early in relation to the prior day’s supply dispensed, where such refills are for the purpose of replacing lost or destroyed medication or providing the patient with the quantity necessary for extended travel away from the community in which the patient resides or for any other bona fide reason that causes the patient to be without medication, when the discontinuation of the medicine would, in the pharmacist‘s professional judgment, place the patient at risk of harm.
