Pharmacy claims audits
- • standards for review of claims
An entity’s finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs. [2013 c.570 §6]
Note: See note under 735.530 (Definitions for ORS 735.530 to 735.552).
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