                                 CODE OF VIRGINIA

PAYMENT OF CLEAN CLAIMS TO ADMINISTRATORS OF PHARMACY BENEFITS (§
38.2-3407.9:03)

A. As used in this section, &#8220;clean claim,&#8221; &#8220;carrier,&#8221;
and &#8220;provider contract,&#8221; shall have the meanings set forth in
subsection A of &#xA7; 38.2-3407.15.

B. Any contract between a carrier and its pharmacy benefits administrator or a
carrier and a participating pharmacy, or its contracting agent, that requires
claims be submitted electronically shall require that payment be made
electronically to the participating provider or its designee for clean claims,
as defined in subsection A of &#xA7; 38.2-3407.15, submitted electronically. An
electronic claim must be submitted in the form required by the carrier and in
compliance with 45 CFR Part 142, as amended, provided that the participating
provider or designee agrees to accept claims details for such payments
electronically, in compliance with 45 CFR Part 142, as amended, and provides
accurate electronic funds transfer information to the carrier.

C. This section shall apply with respect to contracts between a carrier and its
pharmacy benefits administrator or a carrier and a pharmacy, or its contracting
agent, that are entered into, amended, extended, or renewed on or after January
1, 2009.

HISTORY: 2008, c. 104.