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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow
these procedures: (1) The pharmacy contract shall identify and describe in detail the audit
procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice
at least two weeks before conducting the initial on-site audit for each audit cycle. If the
pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-184.htm - 9K - Match Info - Similar pages
15-22-1.1
by the Interstate Commission, but shall not be a member. (c) Corporate records of the Interstate
Commission. The Interstate Commission shall maintain its corporate books and records in accordance
with the bylaws. (d) Qualified immunity, defense and indemnification. (1) The members, officers,
executive director, and employees of the Interstate Commission shall be immune from suit and
liability, either personally or in their official capacity, for any claim for damage to or
loss of property or personal injury or other civil liability caused or arising
out of any actual or alleged act, error or omission that occurred within the scope of Interstate
Commission employment, duties or responsibilities; provided, that nothing in this paragraph
shall be construed to protect any such person from suit and/or liability for any damage, loss,
injury or liability caused by the intentional or willful and wanton misconduct of any
such person. (2) The Interstate Commission shall defend the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/15-22-1.1.htm - 43K - Match Info - Similar pages
41-18-1
or grant accepted by the board pursuant to this paragraph or services borrowed pursuant to
paragraph (g) of this article shall be reported in the annual report of the board. Such report
shall include the nature, amount and conditions if any, of the donation, grant or services
borrowed and the identity of the donor or lender. (i) The board may establish and maintain
such facilities as may be necessary for the transacting of its business. The board may acquire,
hold and convey real and personal property and any interest therein. (j) The board
shall adopt bylaws for the conduct of its business and shall have the power to amend and rescind
these bylaws. The board shall publish its bylaws in convenient form and shall file a copy
thereof and a copy of any amendment thereto with the appropriate agency or officer in each
of the party states. (k) The board annually shall make to the governor and legislature of
each party state a report covering the activities of the board for the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/41-18-1.htm - 24K - Match Info - Similar pages
9-18-1
this compact any and all donations, and grants of money, equipment, supplies, materials, and
services (conditional or otherwise) from any state or the United States or any subdivision
or agency thereof, or interstate agency, or from any institution, person, firm, or corporation,
and may receive, utilize and dispose of the same. "(i) The board may establish and maintain
such facilities as may be necessary for the transacting of its business. The board may acquire,
hold, and convey real and personal property and any interest therein. "(j) The
board shall adopt bylaws, rules, and regulations for the conduct of its business, and shall
have the power to amend and rescind these bylaws, rules, and regulations. The board shall
publish its bylaws, rules, and regulations in convenient form and shall file a copy thereof,
and shall also file a copy of any amendment thereto, with the appropriate agency or officer
in each of the party states. "(k) The board annually shall make to the governor of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/9-18-1.htm - 16K - Match Info - Similar pages
8-20-4
carriers. q. To offer any refunds or other types of inducements to any person for the purchase
of new motor vehicles of a certain line make to be sold to the state or any political subdivision
thereof without making the same offer to all other new motor vehicle dealers in the same line
make within the state. r. To release to any outside party, except under subpoena, or as otherwise
required by law or in an administrative, judicial, or arbitration proceeding, any business,
financial, or personal information which may be from time to time provided by the dealer
to the manufacturer, without the express written consent of the dealer. s. To own an interest
in a new motor vehicle dealership, to operate or control a dealership, to make direct sales
or leases of new motor vehicles to the public in Alabama, or to own, operate, or control a
facility for performance of motor vehicle warranty or repair service work, except as follows:
1. The manufacturer or distributor is owning or operating...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/8-20-4.htm - 34K - Match Info - Similar pages
9-18A-1
under this compact any and all donations and grants of money, equipment, supplies, materials
and services (conditional or otherwise) from any state or the United States or any subdivision
or agency thereof, or interstate agency, or from any institution, person, firm or corporation,
and may receive, utilize and dispose of the same. "(i) The board may establish and maintain
such facilities as may be necessary for the transacting of its business. The board may acquire,
hold and convey real and personal property and any interest therein. "(j) The
board shall adopt bylaws, rules and regulations in convenient form, and shall also file a
copy of any amendment thereto, with the appropriate agency or officer in each of the party
states. "(k) The board annually shall make to the governor of each party state, a report
covering the activities of the board for the preceding year, and embodying such recommendations
as may have been adopted by the board, which report shall be transmitted to the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/9-18A-1.htm - 17K - Match Info - Similar pages
34-23-183
Section 34-23-183 Application. This article shall apply to any audit of the records of a pharmacy
conducted by a managed care company, nonprofit hospital or medical service organization, health
benefit plan, third-party payor, pharmacy benefit manager, a health program administered by
a department of the state, except the Alabama Medicaid Agency, or any entity that represents
those companies, groups, or department. (Act 2012-306, p. 668, §4; Act 2018-457, §1.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-183.htm - 779 bytes - Match Info - Similar pages
27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every health
benefit plan that provides coverage for prescription drugs or devices, or administers a plan,
including, but not limited to, third party administrators for self-insured plans and state
administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds a
card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-22.htm - 3K - Match Info - Similar pages
34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings as used
in this article: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this article if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-181.htm - 3K - Match Info - Similar pages
27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.htm - 17K - Match Info - Similar pages
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