House Bill No. 565, introduced by Representative Spell, aims to enhance the management of third-party liability and claim adjudication within Louisiana's Medicaid program. The bill enacts new provisions under R.S. 46:460.71(E) and 460.76.3, which prohibit managed care organizations from altering claims submitted by healthcare providers unless a rule is promulgated by the department's secretary. It establishes penalties for violations, including withholding payments to managed care organizations, with a minimum penalty of $25,000 for each violation, which can increase to $100,000 for multiple or patterned violations. The bill also mandates that managed care organizations notify the department within two business days of identifying any liable third party for healthcare claims not reflected in the Medicaid Eligibility Verification System.

Additionally, the bill requires the department to provide comprehensive information about third-party insurers to ensure proper claim processing. Managed care organizations are prohibited from denying claims solely based on the existence of other insurance unless specific information is available in the Medicaid system. They must also notify healthcare providers within five business days after receiving payment from a third party, including detailed information about the payment and the insurer. The bill is set to take effect upon the governor's signature or after the expiration of the time for gubernatorial action.