§ 46:460.76 — Prepayment review

Louisiana § 46:460.76

• Jurisdiction: Louisiana
• Title 46: Public Welfare and Assistance

Text

§460.76. Prepayment review
A. A managed care organization or a contractor, assignee, agent, or entity acting on
the behalf of a managed care organization shall be prohibited from requiring any enrolled
provider to be subject to prepayment review unless the requirement is implemented directly
by the department and in accordance with the provisions of the Medical Assistance Programs
Integrity Law, R.S. 46:437.1 et seq.
B. For the purposes of this Section, "prepayment review" means any action by a
managed care organization or a contractor, assignee, agent, or entity acting on the behalf of
a managed care organization requiring a healthcare provider to provide medical record
documentation in conjunction with or after the submission of a claim for payment for
medical services rendered, but before the claim has been adjudicated by the managed care
organization.
C.(1) Nothing in this Section shall prohibit a managed care organization from
notifying the department of healthcare providers suspected of committing fraud and abuse.
(2) Nothing in this Section shall prohibit the department from requiring all managed
care organizations to coordinate efforts to combat and prevent fraud and abuse pursuant to
any requirements ordered by the department in accordance with the Medical Assistance
Programs Integrity Law, R.S. 46:437.1 et seq.
D. The provisions of this Section shall not apply to any dental coordinated care
network as defined in R.S. 46:460.51.

Legislative History

Acts 2022, No. 534, §1.