Did you know that Louisiana made healthcare provider enrollment just a little easier?
Starting a medical practice and hiring healthcare providers is expensive. Insurance companies and managed care organizations will not acknowledge your existence until they have received your completed enrollment application and packet. Even then, it can take three or four contacts for their representatives to acknowledge receipt of your application. Until then, most (maybe all?) have historically refused to pay you for services until they approve your application… often three to six months later.
Health insurance providers and managed care organizations can no longer force Louisiana healthcare providers to finance their business expenses while waiting for network approvals.
In a unanimous vote in both the House and Senate, Louisiana passed HB 595, authored by State Representative Dustin Miller. The bill, signed into law as Act 79 on June 4, 2021, amended the Louisiana Revised Statutes codified at La. R.S. 22:1874 and La. R.S. 46:460.62.
The amendments permit healthcare providers to bill for services and receive payments while awaiting enrollment approvals from commercial insurances and managed care organizations.
Bill Health Insurance Providers and Managed Care Organizations while awaiting network approval.
Louisiana law now requires health insurance providers and managed care organizations operating within the State to treat all new providers as “in-network” or “participating” providers while awaiting network approval. This regulation now applies when:
1. The health insurance provider or managed care organization contracts with a group of healthcare providers of which the new healthcare provider is a member
2. The provider group bills the health insurance provider or managed care organization for the services rendered by the new healthcare provider using a group identification number
3. The health insurance provider or managed care organization has received the required application, including proof of membership on a hospital medical staff, and has not notified the provider group that it denied the application
4. The provider group has submitted a written request agreeing that all existing contract terms apply to the new provider
Louisiana law does not require advanced practice nurses or physician assistants to attain membership on a hospital medical staff if the provider submits a written attestation identifying the collaborating or supervising physician, but only if Louisiana law requires a physician relationship.
The amendments require health insurance providers and managed care organizations to comply within thirty days of receiving a written request from a provider group.
For more information, please see La. R.S. 22:1874(A)(5)(a) et seq. and La. R.S. 46:460.62(A) et seq.
Written By: Landon Tooke, MLS, CHC, CCEP, CPCO, CHCSP, CHSRAP
Twitter: @LandonNTooke
LinkedIn: Landon Tooke
