Authority: IC 27-1-24.5-20

Affected: IC 27-1-24.5-22

Sec. 6. An audit finding of an overpayment or underpayment of a claim:

1. (1) must be based on an actual overpayment or underpayment of an audited claim discovered to include a recoverable error;

2. (2) must not be based on a projection that is based on the number of:

   1. (A) patients who:

      1. (i) have similar diagnoses; and
      2. (ii) are served by the pharmacy; or
   2. (B) prescriptions for or refills of similar prescription drugs that are dispensed by the pharmacy; and
3. (3) must not include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a medication error by the pharmacy, or the identified overpayment is solely based on an extra dispensing fee.

(Department of Insurance; 760 IAC 5-3-6; filed Feb 23, 2023, 9:48 a.m.: 20230322-IR-760220287FRA)