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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2010
SENATE BILL NO. 710
BY SENATOR CHEEK
HEALTH/ACC INSURANCE. Requires the health insurance issuer to pay any new
provider to the contracted network of providers the contracted reimbursement rate of the
network. (8/15/10)
AN ACT1
To enact R.S. 22:1874(A)(5), relative to billing by contracted health care providers; to2
provide with respect to the payment to any new provider to the contracted network3
of providers; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1874(A)(5) is hereby enacted to read as follows: 6
§1874. Billing by contracted health care providers7
A. * * *8
(5)(a) Under certain circumstances and when the provisions of9
Subparagraph (b) are met, a health insurance issuer contracting with a group10
of physicians that bills a health insurance issuer utilizing a group identification11
number, such as the group federal tax identification number or the group12
National Provider Identifier as set forth in 45 CFR162.402 et seq., shall pay the13
contracted reimbursement rate of the physician group for covered health care14
services rendered by a new physician to the group, without health care provider15
credentialing as described in R.S. 22:1009. This provision shall apply in either16
of the following circumstances:17 SB NO. 710
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
(i) When the new physician has already been credentialed by the health1
insurance issuer and the physician’s credentialing is still active with the issuer.2
(ii) When the health insurance issuer has received the required3
credentialing application and information, including proof of active hospital4
privileges, from the new physician and the issuer has not notified the physician5
group that credentialing of the new physician has been denied. 6
(b) A health insurance issuer shall comply with the provisions of7
Subparagraph (a) of this Paragraph no later than thirty days of receipt of a8
written request from the physician group. The written request shall include a9
statement that the physician group agrees that all contract provisions, including10
the provision holding covered persons harmless for charges beyond11
reimbursement by the issuer and deductible, coinsurance and copayments,12
apply to the new physician. Such compliance shall apply to any claims for13
covered services rendered by the new physician to covered persons on dates of14
service no earlier than the date of the written request from the physician group.15
(c) Compliance by a health insurance issuer with the provisions of16
Subparagraph (a) shall not be construed to mean that a physician has been17
credentialed by an issuer or that the issuer is required to list the physician in a18
directory of contracted physicians.19
* * *20
The original instrument was prepared by Cheryl Horne. The following digest,
which does not constitute a part of the legislative instrument, was prepared
by Greg Waddell.
DIGEST
Cheek (SB 710)
Proposed law provides that when certain circumstances are met, a health insurance issuer
contracting with a group of physicians that bills a health insurance issuer utilizing a group
identification number, shall pay the contracted reimbursement rate of the physician group
for covered health care services rendered by a new physician to the group, without health
care provider credentialing as described in present law.
Proposed law provides that a health insurance issuer shall comply with the provisions of
proposed law no later than 30 days of receipt of a written request from the physician group.
Proposed law provides for the requirements of the written request. SB NO. 710
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Effective August 15, 2010.
(Adds R.S. 22:1874(A)(5))
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill.
1. Removes provisions which require a health insurance issuer contracting with
a network of providers that bills a health insurance issuer utilizing a group
identification number to pay any new provider to the contracted network of
providers, the contracted reimbursement rate of the network for a period of
180 days from the date of the first bill.
2. Removes provision which required the new provider to the network of
contracted providers to be credentialed by a contracted base health care
facility of the health insurance issuer.
3. Requires that when certain circumstances are met, a health insurance issuer
contracting with a group of physicians that bills a health insurance issuer
utilizing a group identification number shall pay the contracted
reimbursement rate of the physician group for covered health care services
rendered by a new physician to the group.
4. Requires compliance by a health insurance issuer no later than 30 days of
receipt of a written request from the physician group and provides for the
requirements of the written request.