LA HB565

Managed care organizations are prohibited from amending, down-coding, or paying Medicaid claims at a lower level than submitted by healthcare providers, unless the department promulgates a statewide rule authorizing such practices (which requires approval from both Senate and House Health and Welfare Committees)

MCOs must notify the department within 2 business days when they discover a third-party insurer liable for an enrollee's claims that isn't already in the Medicaid Eligibility Verification System; the department must update the system within 3 business days

MCOs cannot deny, pend, reject, or recoup claims based on third-party liability unless the other insurer's information is available in the state's Medicaid verification system

MCOs must notify providers within 5 business days after receiving payment from a liable third party, including a copy of the explanation of benefits and insurer details

Violations carry penalties of at least $25,000 per violation, increasing to at least $100,000 for multiple violations or pattern of violations; implementation begins August 1, 2025