Virginia Code 38.2-3407.9:03: Payment of clean claims to administrators of pharmacy benefits
A. As used in this section, “clean claim,” “carrier,” and “provider contract,” shall have the meanings set forth in subsection A of § 38.2-3407.15.
Terms Used In Virginia Code 38.2-3407.9:03
- Contract: A legal written agreement that becomes binding when signed.
- Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
B. Any contract between a carrier and its pharmacy benefits administrator or a carrier and a participating pharmacy, or its contracting agent, that requires claims be submitted electronically shall require that payment be made electronically to the participating provider or its designee for clean claims, as defined in subsection A of § 38.2-3407.15, submitted electronically. An electronic claim must be submitted in the form required by the carrier and in compliance with 45 C.F.R. part 142, as amended, provided that the participating provider or designee agrees to accept claims details for such payments electronically, in compliance with 45 C.F.R. 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 and its pharmacy benefits administrator or a carrier and a pharmacy, or its contracting agent, that are entered into, amended, extended, or renewed on or after January 1, 2009.
2008, c. 104.