§ 46:460.84 — Costs

Louisiana § 46:460.84

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

Text

§460.84. Costs
A. The fee for conducting an independent review shall be paid to the independent
reviewer by the managed care organization; except that for reviews conducted in accordance
with R.S. 46:460.90, a dental coordinated care network shall pay the fee for an independent
review to the Louisiana State University School of Dentistry. A provider shall, within ten
days of the date of the decision of the independent reviewer, reimburse a managed care
organization for the fee associated with conducting an independent review when the decision
of the managed care organization is upheld. If the provider fails to submit payment for the
independent review within ten days from the date of the decision, the managed care
organization may withhold future payments to the provider in an amount equal to the cost
of the independent review; however, the managed care organization shall ensure that such
a withholding is clearly delineated on the remittance advice. If a provider fails to properly
reimburse the managed care organization, the department may prohibit that provider from
future participation in the independent review process.
B. The managed care organization shall compensate the independent reviewer within
thirty calendar days of receipt by the managed care organization of the reviewer's bill for
services rendered. If the managed care organization fails to pay the bill for the independent
reviewer's services, then the reviewer may request payment directly from the department
from any funds held by the state that are payable to the managed care organization.
C. The fee for an independent review of a dental claim conducted in accordance with
R.S. 46:460.90 shall be paid in an amount established in a contract or memorandum of
understanding between the department and the Louisiana State University School of
Dentistry.

Legislative History

Acts 2017, No. 349, §2; Acts 2018, No. 284, §1.