Louisiana Revised Statutes 22:1855 – Submission to health insurance issuer
Terms Used In Louisiana Revised Statutes 22:1855
- Claim: means a request by a pharmacist for payment by a health insurance issuer. See Louisiana Revised Statutes 22:1852
- Electronic claim: means the transmission of data for purposes of payment of covered prescription drugs, other products and supplies, and pharmacist services in an electronic data format specified by a health insurance issuer and approved by the department. See Louisiana Revised Statutes 22:1852
- Health insurance issuer: means an insurance company, including a health maintenance organization as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of this Title, unless preempted as an employee benefit plan under the Employee Retirement Income Security Act of 1974. See Louisiana Revised Statutes 22:1852
- insured: means an individual who is enrolled or insured by a health insurance issuer for health insurance coverage. See Louisiana Revised Statutes 22:1852
- Pharmacist: means an individual currently licensed as a pharmacist by the Louisiana Board of Pharmacy to engage in the practice of pharmacy in this state. See Louisiana Revised Statutes 22:1852
- Pharmacist services: means the filling and dispensing of prescription drugs or providing products and supplies, drug therapy, and other patient care services provided by a licensed pharmacist with the intent of achieving outcomes related to the cure, prevention, or management of a disease, elimination or reduction of patient's symptoms, or arresting or slowing of a disease process. See Louisiana Revised Statutes 22:1852
A. For purposes of La. Rev. Stat. 22:1853, a claim shall be deemed to be submitted to the health insurance issuer when a nonelectronic claim is furnished to the health insurance issuer, its agent, or any other party that makes payment directly to the pharmacy or pharmacist, or the insured or enrollee, for the prescription drugs, other products and supplies, and pharmacist services identified on the nonelectronic claim.
B. For purposes of La. Rev. Stat. 22:1854, a claim shall be deemed to be submitted to a health insurance issuer when it is electronically submitted to the health insurance issuer, its agent, or any other party that makes payment directly to the pharmacy or pharmacist for the prescription drugs, other products and supplies, and pharmacist services identified on the electronic claim.
Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Redesignated from La. Rev. Stat. 22:250.55 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.