(215 ILCS 5/512-9) (from Ch. 73, par. 1065.59-9)
Sec. 512-9.
Denial of Payment.
(a) No administrator shall deny payment
to any pharmacy for covered pharmaceutical services or prescription drug
products rendered as a result of the misuse, fraudulent or illegal use of
an identification card unless such identification card had expired, been
noticeably altered, or the pharmacy was notified of the cancellation of
such card. In lieu of notifying pharmacies which have a common ownership,
the administrator may notify a party designated by the pharmacy to receive
such notice, in which case, notification shall not become effective until
5 calendar days after the designee receives notification.
(b) No program administrator may withhold any payment to any pharmacy
for covered pharmaceutical services or prescription drug products beyond
the time period specified in the payment schedule provisions of the agreement,
except for individual claims for payment which have been returned to the pharmacy
as incomplete or illegible. Such returned claims shall be paid if resubmitted
by the pharmacy to the program administrator with the appropriate corrections made.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-10) (from Ch. 73, par. 1065.59-10)
Sec. 512-10.
Failure to Register.
Any third party prescription program
or administrator which operates without a certificate of registration or
fails to register with the Director and pay the fee prescribed by this Article
shall be construed to be an unauthorized insurer as defined in Article VII
of this Code and shall be subject to all penalties contained therein.
The provisions of the Article shall apply to all new programs established
on or after January 1, 1983. Existing programs shall comply with the provisions
of this Article on the anniversary date of the programs that occurs on or
after January 1, 1983.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-11) Sec. 512-11. Examination. The Director or the Director's designee may examine any applicant for or holder of an administrator's registration in accordance with Sections 132 through 132.7 of this Code. If the Director or the examiners find that the administrator has violated this Article or any other insurance-related laws or regulations under the Director's jurisdiction because of the manner in which the administrator has conducted business on behalf of a separately incorporated health care payer, then, unless the health care payer is included in the examination and has been afforded the same opportunity to request or participate in a hearing on the examination report, the examination report shall not allege a violation by the health care payer and the Director's order based on the report shall not impose any requirements, prohibitions, or penalties on the health care payer. Nothing in this Section shall prevent the Director from using any information obtained during the examination of an administrator to examine, investigate, or take other appropriate regulatory or legal action with respect to a health care payer.(Source: P.A. 103-897, eff. 1-1-25.) |
(215 ILCS 5/Art. XXXI.75 heading) ARTICLE XXXI 3/4
PUBLIC INSURANCE ADJUSTERS
AND REGISTERED FIRMS
(Repealed)(Source: Repealed by P.A. 102-135, eff. 7-23-21.)
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