RS 46:460.75
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RS 46:460.75
§460.75. Provider claim payment and information protection
A. If a healthcare provider submits a request, either orally or in writing, to a managed care organization during the time prescribed by state law or regulation in which a managed care organization can subject a claim to any review or audit for purposes of reconsidering the validity of a claim, the managed care organization shall provide, within two business days of such request, a copy of all documentation that has been transmitted between the healthcare provider and the managed care organization, or their respective agents, that is associated with a claim for payment of a service.
A managed care organization may, in lieu of providing a physical copy, provide electronic access of the documentation through the use of a provider portal or other electronic means to the provider. All information or documentation required to be provided to a healthcare provider by a managed care organization pursuant to this Section, whether by physical copy or electronic access, shall be provided at no cost to the healthcare provider.
B.(1) Any healthcare provider contract issued, amended, or renewed on or after January 1, 2021, between a managed care organization, its contracted vendor, or agent and a healthcare provider for the provision of healthcare services to a Medicaid enrollee shall not contain restrictions on methods of payment from the managed care organization or its vendor to the healthcare provider in which the only acceptable payment method for healthcare services rendered requires the healthcare provider to pay a transaction fee, provider subscription fee, or any other type of fee or cost in order to accept payment from the managed care organization for the provision of healthcare services, or that would result in a monetary reduction in the healthcare provider's payment for the healthcare services rendered.
(2)If initiating or changing payments to a healthcare provider using electronic funds transfer payments a managed care organization, its contracted vendor, or agent shall do both of the following:
(a)Notify the healthcare provider if any fees are associated with a particular payment method.
(b)Advise the provider of the available methods of payment and provide clear instructions to the healthcare provider as to how to select an alternative payment method that does not require the healthcare provider to pay a transaction fee, provider subscription fee, or any other type of fee or cost in order to accept payment from the managed care organization for the provision of healthcare services.
C. The provisions of this Section shall not be waived by contract, and any contractual clause in conflict with the provisions of this Section or that purports to waive any requirements of this Section is void.
D. If the managed care organization, its contracted vendor, or agent violates any provision of this Section, the department shall impose penalties on the managed care organization in accordance with contract provisions or rules and regulations promulgated pursuant to the Administrative Procedure Act, except that penalties shall be imposed without the necessity of the department having to issue any prior notice of corrective action.
E. As used in this Section, "electronic funds transfer" means an electronic funds transfer through the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, standard automated clearinghouse network.
Acts 2021, No. 434, §2.