Authority: IC 27-1-24.5-20

Affected: IC 27-1-24.5-22

Sec. 7. (a) Before recoupment of funds may be made based on an audit finding of overpayment or underpayment:

1. (1) a final audit report must be distributed; and
2. (2) except when an audit finds that fraud, willful misrepresentation, or alleged serious abuse has occurred, at least thirty (30) calendar days must elapse after the date on which the final audit report is distributed before the recoupment of funds exceeding ten thousand dollars ($10,000).

(b) A pharmacy benefit manager must remit all monies due to a pharmacy or pharmacist as a result of an underpayment of a claim within thirty (30) calendar days after the final audit report has been delivered to the pharmacy or pharmacist.

(c) Interest on funds described in this section does not accrue during the audit and appeal period.

(Department of Insurance; 760 IAC 5-3-7; filed Feb 23, 2023, 9:48 a.m.: 20230322-IR-760220287FRA)