11 NCAC 24 .0108             CLAIMS PROCESSING

(a)  Each PBM's claims processing service shall be supported by a set of written policies, procedures, and performance standards related to timeliness in payment of claims and its financial operations.

(b)  Each PBM shall develop and implement a claims processing internal audit and a quality assurance program to monitor and improve claims processing services.

(c)  Each PBM shall be accessible to insureds, insurers, and pharmacists by telephone to respond to inquiries about claims payments.

History Note:        Authority G.S. 58-2-40;58-56A-1(4); 58-56A-2;

Eff. September 1, 2025.