Pharmacy claims audits
- • validation of claims
For purposes of ORS 735.540 (Definitions for ORS 735.540 to 735.552) to 735.552 (Pharmacy claims audits), an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim:
(1) An electronic or physical copy of a prescription that complies with ORS chapter 689 if the prescribed drug was, within 14 days of the dispensing date:
(a) Picked up by the patient or the patient’s designee;
(b) Delivered by the pharmacy to the patient; or
(c) Sent by the pharmacy to the patient using the United States Postal Service or other common carrier;
(2) Point of sale electronic register data showing purchase of the prescribed drug, medical supply or service by the patient or the patient’s designee; or
(3) Electronic records, including electronic beneficiary signature logs, electronically scanned and stored patient records maintained at or accessible to the audited pharmacy’s central operations and any other reasonably clear and accurate electronic documentation that corresponds to a claim. [2013 c.570 §8]
Note: See note under 735.530 (Definitions for ORS 735.530 to 735.552).
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