Senate Bill No. by Senator McMath seeks to amend Louisiana law regarding the payment processes for healthcare providers, particularly focusing on the timelines for processing claims submitted by healthcare providers, including pharmacists and pharmacies. The bill reduces the payment timeframe for nonelectronic claims from 45 days to 30 calendar days and for claims requiring prior authorization from 60 days to 10 calendar days. For electronic claims, those with prior authorization must be paid within 10 days, while others must be settled within 25 days. Additionally, health insurance issuers are required to notify providers within two business days when a claim is pended.

The bill also revises the recoupment process for health insurance claims, prohibiting retroactive denial or adjustment of claims submitted in good faith after 180 days, down from the previous 18 months. It removes the option for health insurance issuers to apply a 30-day payment standard and extends these provisions to the Office of Group Benefits, which was previously exempt. Furthermore, the bill eliminates the requirement for just and reasonable grounds for noncompliance, ensuring that the new payment standards are upheld without exceptions. These amendments are set to take effect on August 1, 2026.

Statutes affected:
SB465 Original: 22:1832(A), 22:1833(B), 22:1838(F), 22:1853(A), 22:1853(B)(1), 22:1853(C), 22:1854(A), 22:1854(B), 22:1854(C)