La. Admin. Code tit. 40 § I-313
Current through Register Vol. 50, No. 11, November 20, 2024
Section I-313 - Communication between Health Care Providers and Insurance CarriersA. Any communication between the health care provider and the insurance carrier related to medical bill processing shall be of sufficient specific detail to allow the responder to easily identify the information required to resolve the issue or question related to the medical bill. Generic statements that simply state a conclusion such as "insurance carrier improperly reduced the bill" or "health care provider did not document" or other similar phrases with no further description of the factual basis for the sender's position do not satisfy the requirements of this Section.B. Utilization of the ASC X12N Reason Codes, or as appropriate, the NCPDP Reject Codes, by the insurance carrier when communicating with the health care provider or its agent or assignee, provides a standard mechanism to communicate issues associated with the medical bill.C. Communication between the health care provider and insurance carrier related to medical bill processing shall be made by telephone or electronic transmission unless the information cannot be sent by those media, in which case the sender shall send the information by mail or personal delivery.D. The insurance carrier's failure to comply with any requirements of this Rule shall result in an administrative violation LAC 40:109.A.La. Admin. Code tit. 40, § I-313
Promulgated by the Louisiana Workforce Commission, Office of Workers' Compensation, LR 37:3546 (December 2011).AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1203.2.