Pharmacy benefits managers would face deadlines for paying clean claims

Pharmacy benefits managers would have to send pharmacies payment for clean claims by set deadlines. The deadlines cover clean claims that pharmacies submit electronically or on paper. A clean claim has no problem that blocks timely payment. A claim also counts as clean if the manager does not flag a problem on time. The deadlines run from when the manager receives the claim. This rule would start on the first day of the ninth month after enactment.

Pharmacy benefits managers would have to tell pharmacies promptly about problems with their claims. This applies when a manager finds a problem with a claim submitted by a pharmacy. The notice must list the problems and the information needed for payment. After a pharmacy sends the needed information, its claim becomes clean within 10 days unless the manager flags a remaining problem or a problem in the new information. The notice period starts when the manager receives the claim. This rule would start on the first day of the ninth month after enactment.

Pharmacy benefits managers would face a penalty for paying a pharmacy's clean claim late. This covers late payments on pharmacies' clean claims. A natural disaster or another rare, unexpected event must prevent timely processing to excuse the penalty. A cybersecurity breach or data security issue involving the manager does not excuse it. The penalty runs from the day after payment is due until proper payment is made. This rule would start on the first day of the ninth month after enactment.