LA. Rev. Statutes-Title 22. Insurance
Standards for receipt and processing of nonelectronic claims
See bold sections below:
A. (1) Any nonelectronic claim by a healthcare provider under a contract with a health insurance issuer, for provision of healthcare services, submitted by the provider or its agent within the period of time set forth by the health insurance issuer for the timely filing of claims or resubmitted because the original claim was not an accepted claim or not a clean claim shall be paid, denied, or pended not more than thirty calendar days from the date upon which a nonelectronic clean claim is received by the issuer or its agent.
(2) Any nonelectronic claim by a healthcare provider under a contract with a health insurance issuer, for provision of healthcare services that have prior authorization by the health insurance issuer, submitted by the provider or its agent within the period of time set forth by the health insurance issuer for the timely filing of claims shall be paid, denied, or pended not more than ten calendar days from the date upon which a nonelectronic clean claim is received by the issuer or its agent, unless it is not payable under the terms of the applicable contract of insurance.
(3) Any other nonelectronic claim for health insurance coverage benefits submitted for payment by an enrollee or insured or by a noncontracted healthcare provider rendering covered healthcare services, or by the provider’s agent, shall be paid, denied, or pended not more than forty-five days from the date upon which a nonelectronic clean claim is received by the issuer or its agent, unless it is not payable under the terms of the applicable contract of insurance.
(4) For purposes of this Subsection, the issuer shall either provide written notice to the provider within two business days that a claim is pended or allow the provider internet access to such information.
B. (1) Health insurance issuers shall have appropriate procedures approved by the department to assure compliance with this Subpart. Health insurance issuers shall have appropriate handling procedures approved by the department for the acceptance of nonelectronic claim submissions. Such procedures shall include but not be limited to the following:
(a) A process for documenting the date of actual receipt of nonelectronic claims.
(b) A process for reviewing nonelectronic claims for accuracy and acceptability.
(c) A process for prevention of loss of such claims.
(2) Such procedures shall assure that all such claims received are reviewed for determination as to whether such claims are accepted or clean claims.
(3) The department may promulgate and adopt additional handling procedures consistent with this Section by rule pursuant to the Administrative Procedure Act.
C. Health insurance issuers shall establish appropriate procedures approved by the department to assure that any health care provider who is not paid within the time frames specified in this Section receives a late payment adjustment equal to twelve percent per annum of the amount due.
D. The provisions of this Subpart shall apply to the Office of Group Benefits.