Page 1 of 3
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2010 ENROLLED
SENATE BILL NO. 710
BY SENATOR CHEEK
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
ยง1874. Billing by contracted health care providers7
A. * * *8
(5)(a) Under certain circumstances and when the provisions of9
Subparagraph (b) of this Paragraph are met, a health insurance issuer10
contracting with a group of physicians that bills a health insurance issuer11
utilizing a group identification number, such as the group federal tax12
identification number or the group National Provider Identifier as set forth in13
45 CFR162.402 et seq., shall pay the contracted reimbursement rate of the14
physician group for covered health care services rendered by a new physician15
to the group, without health care provider credentialing as described in R.S.16
22:1009. This provision shall apply in either of the following circumstances:17
(i) When the new physician has already been credentialed by the health18
insurance issuer and the physician's credentialing is still active with the issuer.19
(ii) When the health insurance issuer has received the required20
credentialing application and information, including proof of active hospital21
ACT No. 897 SB NO. 710 ENROLLED
Page 2 of 3
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
privileges, from the new physician and the issuer has not notified the physician1
group that credentialing of the new physician has been denied.2
(b) A health insurance issuer shall comply with the provisions of3
Subparagraph (a) of this Paragraph no later than thirty days after receipt of a4
written request from the physician group. The written request shall include a5
statement that the physician group agrees that all contract provisions, including6
the provision holding covered persons harmless for charges beyond7
reimbursement by the issuer and deductible, coinsurance and copayments,8
apply to the new physician. Such compliance shall apply to any claims for9
covered services rendered by the new physician to covered persons on dates of10
service no earlier than the date of the written request from the physician group.11
(c) Compliance by a health insurance issuer with the provisions of12
Subparagraph (a) of this Paragraph shall not be construed to mean that a13
physician has been credentialed by an issuer or that the issuer is required to list14
the physician in a directory of contracted physicians.15
(d) If, upon compliance with Subparagraph (a) of this Paragraph, a16
health insurance issuer completes the credentialing process on the new17
physician and determines that the physician does not meet the issuer's18
credentialing requirements, the following actions shall be permitted:19
(i) The health insurance issuer may recover from the physician or the20
physician group an amount equal to the difference between appropriate21
payments for in-network benefits and out-of-network benefits provided that the22
health insurance issuer has notified the applicant physician of the adverse23
determination and provided that the health insurance issuer has initiated action24
regarding such recovery within thirty days of the adverse determination.25
(ii) The physician or the physician group may retain any deductible,26
coinsurance or copayment collected or in the process of being collected as of the27
date of receipt of the issuer's determination, so long as the amount is not in28
excess of the amount owed by the insured or enrollee for out-of-network29
services.30 SB NO. 710 ENROLLED
Page 3 of 3
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
* * *1
Section 2. This Act shall become effective on January 1, 2011.2
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: