Enrolled Bill Summary

House Bill 2292	House Author: Hunter et al.
Effective: 9-1-11	Senate Sponsor: Van de Putte

House Bill 2292 amends Insurance Code provisions relating to the payment of claims to and the audit of a pharmacy and pharmacist. Previous law required a health maintenance organization (HMO) or other health insurer that affirmatively adjudicates an electronically submitted pharmacy claim to pay the total amount of the claim not later than the 21st day after the date the claim was affirmatively adjudicated. The bill shortens that deadline to the 18th day after the date the claim was affirmatively adjudicated; expands the applicability of the deadline to include claims submitted to a pharmacy benefit manager that administers pharmacy claims on behalf of such an HMO or health insurer; specifies that the payment of the claim be through electronic funds transfer; and makes the deadline to pay an affirmatively adjudicated pharmacy claim that is not electronically submitted not later than the 21st day after the date on which the claim was affirmatively adjudicated. The bill prohibits such an HMO, health insurer, or pharmacy benefit manager from using extrapolation to complete an audit of a provider who is a pharmacist or pharmacy.  The bill prohibits an HMO or health insurer from requiring an extrapolation audit of a pharmacist or pharmacy as a condition of the pharmacist's or pharmacy's participation in the HMO or health insurer's contract, network, or program.