HLS 10RS-1344 ORIGINAL
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Regular Session, 2010
HOUSE BILL NO. 441
BY REPRESENTATIVE KLECKLEY
INSURANCE/HEALTH-ACCID: Provides with respect to remittance advices on pharmacy
and pharmacist claims
AN ACT1
To amend and reenact R.S. 22:1852(11), to enact R.S. 22:1856.1, and to repeal R.S.2
22:1856(C), (D), and (E), relative to pharmacy and pharmacist claims; to require3
that a remittance advice on any such claim be an electronic communication; to delete4
the requirement that such a remittance advice be postmarked; and to provide for5
related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 22:1852(11) is hereby amended and reenacted and R.S. 22:1856.18
is hereby enacted to read as follows: 9
§1852. Definitions10
As used in this Subpart, the following terms shall be defined as follows:11
* * *12
(11) "Remittance advice" means a written or an electronic communication13
explaining the health insurance issuer's action on each claim adjudicated by the14
issuer. Such communication is sent by a health insurance issuer or its agent to a15
retail or mail order pharmacist or his agent or retail or mail order pharmacy or its16
agent.17
* * *18
§1856.1. Remittance advice19
A. Each remittance advice generated by a health insurance issuer or its agent20
to a pharmacist or his agent or pharmacy or its agent shall be transmittted within21 HLS 10RS-1344 ORIGINAL
HB NO. 441
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seven business days of payment and shall include the following information, clearly1
identified and totaled for each claim listed:2
(1) Unique enrollee or insured identification number.3
(2) Patient claim number or patient account number.4
(3) Date that the prescription was filled.5
(4) National Drug Code.6
(5) Quantity dispensed.7
(6) Price submitted to the health insurance issuer or its contractor.8
(7) Amount paid by the health insurance issuer or its contractor.9
(8) Dispensing fee.10
(9) Provider fee.11
(10) Taxes.12
(11) Enrollee or insured liability, specifying any coinsurance, deductible,13
copayment, or noncovered amount.14
(12) Any amount adjusted by the health insurance issuer or its contractor and15
the reason for adjustment.16
(13) Any other deduction or charge, listed separately.17
(14) A toll-free telephone number for assistance with the remittance advice.18
B. The provisions of Subsection A of this Section shall not be construed to19
require the adoption of any particular form of remittance advice which is otherwise20
in compliance with the provisions of this Section.21
C. No remittance advice shall contain any information that would cause a22
violation of the Health Insurance Portability and Accountability Act (42 U.S.C. 132023
et seq.). All electronic remittance advices shall follow the ANSI X12N 835 HIPAA24
Standard Transaction file format or any subsequent standards that are required.25
Section 2. R.S. 22:1856(C), (D), and (E) are hereby repealed in their entirety.26 HLS 10RS-1344 ORIGINAL
HB NO. 441
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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)]
Kleckley HB No. 441
Abstract: Requires that a remittance advice on a pharmacy or pharmacist claim be an
electronic communication and deletes the requirement that such a remittance advice
be postmarked.
Present law, relative to pharmacy and pharmacist claims, 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.
Proposed law requires that a remittance advice on a pharmacy or pharmacist claim be an
electronic communication; otherwise retains present law.
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 be postmarked within seven
business days of payment and include certain information, clearly identified and totaled for
each claim listed.
Proposed law deletes the requirement that the remittance advice be postmarked within seven
business days of payment; instead requires only that such remittance advice be transmitted
within seven business days of payment. Otherwise retains present law.
(Amends R.S. 22:1852(11); Adds R.S. 22:1856.1; Repeals R.S. 22:1856(C), (D), and (E))