House Bill No. [insert number] aims to enhance the management of third-party liability and claim adjudication within Louisiana's state medical assistance program. The bill introduces 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 in any way that deviates from how the claims were billed. Violations of this provision will result in the Louisiana Department of Health withholding payments to the managed care organization, with penalties starting at $25,000 for each violation and potentially increasing to $100,000 for multiple or patterned violations.

Additionally, the bill mandates that managed care organizations notify the Department of Health within five business days upon discovering any other health insurance coverage for a Medicaid enrollee that is not reflected in the Medicaid Eligibility Verification System. This notification must include specific details about the third-party insurance, such as the insurer's contact information and policyholder details. Furthermore, managed care organizations are restricted from denying claims based solely on the existence of other insurance unless all relevant information is available in the Medicaid system. The bill is set to take effect upon the governor's signature or after the designated period for gubernatorial action.