RSA 318:63 · Mandatory Appeals Process

318:63 Mandatory Appeals Process. –
I. Each entity that conducts an audit of a pharmacy shall establish an appeals process under which a pharmacy may appeal within 30 days after the report an unfavorable audit report to the entity.
II. If, following the appeal, the entity finds that an unfavorable audit report or any portion of the unfavorable audit report is unsubstantiated, the entity shall dismiss the unsubstantiated portion of the audit report without any further proceedings unless outlined in the contract.
III. Each entity conducting an audit shall provide a copy, if required under contractual terms, of the audit findings to the plan sponsor after completion of any appeals process.
IV. If any portion of an unfavorable audit report is not dismissed within 30 days after an appeal is made under paragraph I, the pharmacy may request a hearing from the insurance department pursuant to RSA 400-A:17.
Source. 2013, 159:1, eff. Jan. 1, 2014. 2020, 39:11, eff. Sept. 27, 2020.