House Bill No. by Representative Spell aims to enhance the state medical assistance program by enacting new provisions related to claim payment information and third-party liability. Specifically, it introduces R.S. 46:460.71(E), which prohibits managed care organizations from altering claims submitted by healthcare providers unless authorized by the department through specific rules. Violations of this provision will result in financial penalties, with the department withholding payments of at least $25,000 for each infraction. Additionally, the bill establishes R.S. 46:460.76.3, which mandates that managed care organizations notify the department of any known third-party liability for healthcare claims within two business days and provides guidelines for the information that must be included in such notifications.

The bill also stipulates that managed care organizations cannot deny claims based solely on the existence of a liable third party unless specific information is available in the Medicaid Eligibility Verification System. Furthermore, it requires managed care organizations to notify healthcare providers within five business days after receiving payment from a third party, detailing the payment and relevant information about the insurer. The department is empowered to impose stricter penalties for repeated violations, with a minimum penalty of $100,000 for patterns of violations. The provisions of this act will take effect upon the governor's signature or after the specified legislative process, with implementation of the new claim information requirements set to begin on August 1, 2025.