HLS 10RS-641 ORIGINAL
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2010
HOUSE BILL NO. 170
BY REPRESENTATIVE LEBAS
INSURANCE/HEALTH: Adds worker's compensation insurers to those entities required
to generate a remittance advice for each pharmacy claim
AN ACT1
To amend and reenact R.S. 22:1852(1) and (11) and 1856(C)(introductory paragraph) and2
(6), (7), and (12), relative to pharmacy claims; to require worker's compensation3
insurers to generate a remittance advice on each pharmacy claim; and to provide for4
related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 22:1852(1) and (11) and 1856(C)(introductory paragraph) and (6),7
(7), and (12) are hereby amended and reenacted to read as follows:8
§1852. Definitions9
As used in this Subpart, the following terms shall be defined as follows:10
(1) "Claim" means a request by a pharmacist for payment by a health11
insurance issuer or a worker's compensation insurer.12
* * *13
(11) "Remittance advice" means a written or electronic communication14
explaining the health insurance issuer's or the worker's compensation insurer's action15
on each claim adjudicated by the issuer or insurer. Such communication is sent by16
a health insurance issuer or its agent or a worker's compensation insurer or its agent17
to a retail or mail order pharmacist or his agent or retail or mail order pharmacy or18
its agent.19
* * *20 HLS 10RS-641 ORIGINAL
HB NO. 170
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are additions.
§1856. Thirty-day payment standard; limitations on claim filing and audits;1
remittance advice2
* * *3
C. Each A remittance advice shall be generated by a each health insurance4
issuer or its agent and each worker's compensation insurer or its agent to a5
pharmacist or his agent or pharmacy or its agent, shall be postmarked within seven6
business days of payment, and shall include the following information, clearly7
identified and totaled for each claim listed:8
* * *9
(6) Price submitted to the health insurance issuer or its contractor. or the10
worker's compensation insurer or its contractor. 11
(7) Amount paid by the health insurance issuer or its contractor . or the12
worker's compensation insurer or its contractor.13
* * *14
(12) Any amount adjusted by the health insurance issuer or its contractor or15
the worker's compensation insurer or its contractor and the reason for adjustment.16
* * *17
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
LeBas HB No. 170
Abstract: Adds worker's compensation insurers to those entities required to generate a
remittance advice on each pharmacy claim.
Present law defines a "claim" as a request by a pharmacist for payment by a health insurance
issuer.
Proposed law additionally defines a "claim" as a request by a pharmacist for payment by a
worker's compensation insurer.
Present law defines a "remittance advice" as a written or electronic communication
explaining the health insurance issuer's action on each claim adjudicated by the issuer.
Further specifies that such communication is sent by a health insurance issuer or its agent
to a pharmacist or his agent or a pharmacist or its agent. HLS 10RS-641 ORIGINAL
HB NO. 170
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Proposed law additionally defines a "remittance advice" as a written or electronic
communication explaining the worker's compensation insurer's action on each claim
adjudicated by the insurer. Further specifies that such communication is sent by a health or
a worker's compensation insurer or its agent to a retail or mail order pharmacist or his agent
or retail or mail order pharmacy or its agent.
Present law requires that each remittance advice generated by a health insurance issuer or
its agent to a pharmacist or his agent or pharmacy or its agent have payment attached and
include the following information, clearly identified and totaled for each claim listed:
(1)Unique enrollee or insured identification number.
(2)Patient claim number or patient account number.
(3)Date that the prescription was filled.
(4)National Drug Code.
(5)Quantity dispensed.
(6)Price submitted to the health insurance issuer.
(7)Amount paid by the health insurance issuer.
(8)Dispensing fee.
(9)Provider fee.
(10)Taxes.
(11)Enrollee or insured liability, specifying any coinsurance, deductible, copayment, or
noncovered amount.
(12)Any amount adjusted by the health insurance issuer or its contractor and the reason
for adjustment.
(13)Any other deduction or charge, listed separately.
(14)A toll-free telephone number for assistance with the remittance advice.
Proposed law provides that a remittance advice shall be generated by each health insurance
issuer or its agent and each worker's compensation insurer or its agent to a pharmacist or his
agent or pharmacy or its agent, shall be postmarked within seven business days of payment,
and shall include all of the information listed in present law, clearly identified and totaled
for each claim listed, and as follows:
(1)Price submitted to the worker's compensation insurer.
(2)Amount paid by the worker's compensation insurer.
(3)Any amount adjusted by the worker's compensation insurer and the reason for
adjustment.
(Amends R.S. 22:1852(1) and (11) and 1856(C)(intro. para.) and (6), (7), and (12))