Senate Bill 881 amends various sections of the Tennessee Code Annotated related to pharmacy benefits managers (PBMs). The bill introduces new definitions, including "clean claim," "duplicate claim," "pay," and "submitted," which clarify the criteria for claims processing and payment by PBMs. It establishes prompt payment standards, requiring PBMs to pay clean claims within specified timeframes—30 days for paper submissions and 14 days for electronic submissions. Additionally, the bill mandates that PBMs provide timely information to providers for claim submissions and imposes penalties for non-compliance with these standards, with the potential for fines based on the percentage of clean claims processed.

The bill also includes provisions for regulatory oversight by the commissioner, who is tasked with ensuring that PBMs adhere to the new standards. If a PBM fails to meet the required thresholds for processing clean claims, the commissioner can levy penalties ranging from $10,000 to $200,000, depending on the severity of the violations. Furthermore, the commissioner has the authority to issue cease and desist orders and conduct examinations to ensure compliance. The act is set to take effect upon becoming law, emphasizing the importance of timely and accurate claims processing in the pharmacy benefits management sector.

Statutes affected:
Introduced: 56-7-3110, 56-2-305(c), 56-2-305, 56-7-3102, 56-7-3206(c)(3)(A), 56-7-3206