This text of Louisiana § 46:460.72 (Medicaid managed care organization provider notice) is published on Counsel Stack Legal Research, covering Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
§460.72. Medicaid managed care organization provider notice
A. Each Medicaid managed care organization shall comply with the following notice
provisions regarding contracted provider status and ability to begin providing services and
submitting claims for reimbursement:
(1)Any Medicaid managed care organization that contracts with or enrolls a provider
into its provider network shall furnish written notice to the provider that informs the provider
of the effective date of the contract and enrollment.
(2)Unless otherwise authorized by law, a provider shall not submit Medicaid
reimbursement claims for any services provided prior to the effective date indicated in the
written notice.
(3)The Medicaid managed care organization shall send the written notice required
in this Subsection to the
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§460.72. Medicaid managed care organization provider notice
A. Each Medicaid managed care organization shall comply with the following notice
provisions regarding contracted provider status and ability to begin providing services and
submitting claims for reimbursement:
(1) Any Medicaid managed care organization that contracts with or enrolls a provider
into its provider network shall furnish written notice to the provider that informs the provider
of the effective date of the contract and enrollment.
(2) Unless otherwise authorized by law, a provider shall not submit Medicaid
reimbursement claims for any services provided prior to the effective date indicated in the
written notice.
(3) The Medicaid managed care organization shall send the written notice required
in this Subsection to the last mailing address and last email address submitted by the
provider.
B. Each Medicaid managed care organization shall comply with the following notice
provisions regarding contracted provider re-credentialing:
(1) Each Medicaid managed care organization shall provide a minimum of three
written notices to a contracted provider with information regarding the re-credentialing
process, including requirements and deadlines for compliance. The first notice shall be
issued by the Medicaid managed care organization no later than six months prior to the
expiration of the provider's current credentialing. The notice shall include the effective date
of termination if the provider fails to meet the requirements and deadlines of the
re-credentialing process.
(2) The Medicaid managed care organization shall send the written notices required
in this Subsection to the last mailing address and last email address submitted by the
provider.
(3) If the provider fails to timely submit all required documents and meet all
re-credentialing requirements, the Medicaid managed care organization shall send a
termination notice to the provider with an effective date of termination to be fifteen days
after the date of the notice. The Medicaid managed care organization shall send the
termination notice via certified mail to the provider's last mailing address as submitted by the
provider. The Medicaid managed care organization shall be responsible for paying any
claims for services delivered prior to the termination date specified in the notice.
C. If a Medicaid managed care organization terminates a provider and removes a
provider from its provider network for reasons other than failure to comply with the
re-credentialing process set forth in Subsection B of this Section, the Medicaid managed care
organization shall send written notice of the termination via certified mail to the last known
mailing address submitted by the provider. The termination notice shall include the effective
date of the termination. The termination date shall be fifteen days from the date of the notice
if the termination is pursuant to R.S. 46:460.73(A). The termination shall be immediate if
the termination is pursuant to R.S. 46:460.73(B) or due to the loss of required license.
D. A provider shall give written notice of any change in licensure or accreditation
status to each Medicaid managed care organization with which it is contracted or enrolled
in a provider network. The provider shall furnish such written notice to the Medicaid
managed care organization within two business days of the provider's knowledge of the
change.