§1879. Louisiana consumer health care provider network disclosure
A.
(1)Within thirty days of the effective date of a new contract, each hospital or
ambulatory surgical center, hereinafter referred to as "facility" or "contracted facility" for
purposes of this Section, shall provide to each health insurance issuer with which it contracts,
the National Provider Identifier (NPI) as set forth in 45 CFR 162.402 et seq., name, business
address, and business telephone number of each individual or group of anesthesiologists,
pathologists, radiologists, emergency medicine physicians, and neonatologists who provide
services at that facility. Thereafter, the facility shall notify each health insurance issuer of any
changes to the information as soon as possible but not later than thirty days followi Free access — add to your briefcase to read the full text and ask questions with AI
§1879. Louisiana consumer health care provider network disclosure
A.(1) Within thirty days of the effective date of a new contract, each hospital or
ambulatory surgical center, hereinafter referred to as "facility" or "contracted facility" for
purposes of this Section, shall provide to each health insurance issuer with which it contracts,
the National Provider Identifier (NPI) as set forth in 45 CFR 162.402 et seq., name, business
address, and business telephone number of each individual or group of anesthesiologists,
pathologists, radiologists, emergency medicine physicians, and neonatologists who provide
services at that facility. Thereafter, the facility shall notify each health insurance issuer of any
changes to the information as soon as possible but not later than thirty days following any
change.
(2) Within thirty days of the effective date of a new contract, each individual or
group of anesthesiologists, pathologists, radiologists, emergency medicine physicians, and
neonatologists who provide services at a contracted facility shall provide the health insurance
issuer with which it is contracted, the NPI, name, business address, and business telephone
number of each group or individual so contracted. Thereafter, the group or individual so
contracted shall notify each health insurance issuer of any changes to the information as soon
as possible but not later than thirty days following any change.
B.(1) Based on information received pursuant to Paragraphs (A)(1) and (2) of this
Section, a health insurance issuer shall report on its website in a format that is clear and easy
for its enrollees to understand, the following information arranged by contracted facility:
(a) Facility name, address, and phone number.
(b) The names, business addresses, and business telephone numbers of each
individual or group of anesthesiologists, pathologists, radiologists, emergency medicine
physicians, and neonatologists who provide services at that facility and who are contracted
with the health insurance issuer.
(2) For each specialty at each contracted facility, there shall be a clear indication
when the health insurance issuer has no contract in place with any of the individuals or
groups of anesthesiologists, pathologists, radiologists, emergency medicine physicians, and
neonatologists who provide services at that contracted facility.
(3) A health insurance issuer shall update its website in accordance with the Network
Provider Directory Accessibility and Accuracy Act, R.S. 22:1020.1 et seq.
C. A health insurance issuer shall provide a link to its website containing the
information described in Subsection B of this Section to the Department of Insurance. The
Department of Insurance shall make the links received from health insurance issuers
available on its website.
D. Except as otherwise provided in Subsection G of this Section, the Department of
Insurance may promulgate rules and regulations to provide for civil fines payable by a health
insurance issuer not to exceed five hundred dollars for each and every act of violation of the
requirements of this Section, not to exceed an aggregate fine of fifty thousand dollars. For
purposes of this Subsection, "act of violation" is limited to an intentional act or an act of
gross negligence.
E. The Louisiana Department of Health may promulgate rules and regulations to
provide for civil fines payable by a health care provider not to exceed five hundred dollars
for each and every act of violation of the requirements of this Section, not to exceed an
aggregate fine of fifty thousand dollars. For purposes of this Subsection, "act of violation"
is limited to an intentional act or an act of gross negligence.
F. A health insurance issuer that reports information received from a health care
provider shall indemnify and hold the health care provider harmless for the nonintentional
erroneous or incomplete information provided by the health care provider to the health
insurance issuer under the provisions of this Section. A health care provider that provides
information to a health insurance issuer under the provisions of this Section shall indemnify
and hold the health insurance issuer harmless for nonintentional erroneous or incomplete
information reported by the health insurance issuer under the provisions of this Section. The
penalties under this Section shall be the exclusive remedy for any violations and there shall
be no independent cause of action by any person based upon such violation or other
information reported hereunder.
G. The provisions of this Section shall apply to the Office of Group Benefits;
however, the commissioner of insurance shall not be authorized to levy a fine against the
Office of Group Benefits. If the commissioner of insurance concludes that the Office of
Group Benefits has violated this Section, the commissioner of insurance shall notify the
commissioner of administration in writing within sixty days of such violation.