Louisiana Revised Statutes 46:460.84 – 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.
Terms Used In Louisiana Revised Statutes 46:460.84
- Contract: A legal written agreement that becomes binding when signed.
- Dental coordinated care network: means a managed care organization or prepaid coordinated care network, as defined in this Section, that provides or administers only dental benefits for Medicaid recipients. See Louisiana Revised Statutes 46:460.51
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
- provider: means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution that provides healthcare or professional services to individuals enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
- services: means the services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 46:460.51
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 La. Rev. Stat. 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 La. Rev. Stat. 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.
Acts 2017, No. 349, §2; Acts 2018, No. 284, §1.