83rd Texas Legislature, Regular Session, House Bill 1358, Chapter 915 Page: 1 of 14
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CHAPTER 915 H.B. No. 1358
1 - AN ACT
2 relating to procedures for certain audits of pharmacists and
3 pharmacies.
4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
5 SECTION 1. Chapter 1369, Insurance Code, is amended by
6 adding Subchapter F to read as follows:
7 SUBCHAPTER F. AUDITS OF PHARMACISTS AND PHARMACIES
8 Sec. 1369.251. DEFINITIONS. In this subchapter:
9 (1) "Desk audit" means an audit conducted by a health
10 benefit plan issuer or pharmacy benefit manager at a location other
11 than the location of the pharmacist or pharmacy. The term includes
12 an audit performed at the offices of the plan issuer or pharmacy
13 benefit manager during which the pharmacist or pharmacy provides
14 requested documents for review by hard copy or by microfiche, disk,
15 or other electronic media. The term does not include a review
16 conducted not later than the third business day after the date a
17 claim is adjudicated provided recoupment is not demanded.
18 (2) "Extrapolation" means a mathematical process or
19 technique used by a health benefit plan issuer or pharmacy benefit
20 manager that administers pharmacy claims for a health benefit plan
21 issuer in the audit of a pharmacy or pharmacist to estimate audit
22 results or findings for a larger batch or group of claims ,not
23 reviewed by the plan issuer or pharmacy benefit manager.
24 (3) "Health benefit plan" means a plan that provides1
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Texas. Legislature. House of Representatives. 83rd Texas Legislature, Regular Session, House Bill 1358, Chapter 915, legislative document, June 14, 2013; [Austin, Texas]. (https://texashistory.unt.edu/ark:/67531/metapth438984/m1/1/: accessed May 5, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.