Louisiana Revised Statutes Tit. 46, § 460.76.3. Claim information; third-party liability

B. (1) A managed care organization shall provide notification to the department no later than two business days from the date the managed care organization verifies or has knowledge of the existence of any health insurer or other third party that is legally liable for payment of all or part of a claim for healthcare services furnished under the Medicaid state plan to an enrollee when the health insurer or other liable third party is not reflected on the Medicaid Eligibility Verification System. The notification shall include, at minimum, all of the following information about the health insurer or other liable third party:

(2) The department may promulgate rules or may include requirements in the Medicaid managed care organization manual as necessary for the implementation of this Section.

(3) The department shall cause the information contained in the notification to be reflected in the Medicaid Eligibility Verification System no later than three business days from receiving a notice pursuant to this Subsection.

(1) The name, address, and phone number of the liable third party or health insurance issuer.

(2) The policyholder information, including the policyholder name, policy number, and group number.

(3) The effective date of coverage by the liable third party or health insurance issuer and the scope of coverage of the liable third party or health insurance issuer, if the scope of coverage is limited.

(1) A copy of the explanation of benefits provided to the managed care organization as a result of payment being made to the managed care organization for the healthcare services rendered by the healthcare provider.

(2) The name, address, and phone number of the health insurer or other liable third party.

(3) The policyholder information, including the policyholder name, policy number, and group number.

(4) The effective date of coverage.

(5) The scope of coverage, if the scope of coverage is limited.