This bill enacts new provisions under R.S. 46:460.71(E) and 460.76.3, which focus on the state medical assistance program, specifically regarding claim payment information and third-party liability. The new language prohibits managed care organizations from altering claims submitted by healthcare providers unless a rule is promulgated by the department. Violations of this provision will result in the department withholding payments to the managed care organization, with penalties starting at $25,000 for each violation. Additionally, the bill outlines the requirements for managed care organizations to notify the department about any third-party liability for claims, including specific information that must be provided.

Furthermore, the bill mandates that managed care organizations cannot deny claims based solely on the existence of a liable third party unless the necessary information is available in the Medicaid Eligibility Verification System. It also requires organizations to notify healthcare providers within five business days after receiving payment from a third party, detailing the payment and coverage information. The department is empowered to impose penalties for violations, with a minimum penalty of $25,000, which can increase to $100,000 for multiple or patterned violations. The provisions of this act will take effect on August 1, 2025.