HLS 16RS-977 ORIGINAL
2016 Regular Session
HOUSE BILL NO. 835
BY REPRESENTATIVE SEABAUGH
INSURANCE/HEALTH: Provides relative to audits of pharmacy records
1 AN ACT
2To amend and reenact R.S. 22:1856(B), relative to audits of pharmacy records; to specify
3 the timing of such audits; and to provide for related matters.
4Be it enacted by the Legislature of Louisiana:
5 Section 1. R.S. 22:1856(B) is hereby amended and reenacted to read as follows:
6 ยง1856. Thirty-day payment standard; limitations on claim filing and audits;
7 remittance advice
8 * * *
9 B. Health insurance issuers that limit the period of time that a pharmacist or
10 pharmacy under contract for delivery of covered benefits has to submit claims for
11 payment under R.S. 22:1853 or 1854 shall have the same limited period of time
12 following payment of such claims to perform any review or audit for purposes of
13 reconsidering the validity of such claims. This Subsection shall not apply to audits
14 conducted according to the provisions of R.S. 22:1856.1.
15 * * *
16 Section 2. The provisions of this Act shall apply only to contracts entered into,
17amended, extended, or renewed on or after January 1, 2017.
Page 1 of 2
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-977 ORIGINAL
HB NO. 835
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)]
HB 835 Original 2016 Regular Session Seabaugh
Abstract: Eliminates a conflict in present law relative to the timing of onsite audits.
Present law provides for criteria for the conduct of an onsite audit of the records of a
pharmacy by a managed care company, insurance company, third-party payor, or the
representative of the managed care company, including a pharmacy benefit manager,
insurance company, or third-party payor. Among such criteria is a limitation of such an audit
at a particular pharmacy by any such entity to one time annually except, however, when an
entity must return to a pharmacy to complete an audit already in progress, or there is an
identified history of errors, an identified activity which a reasonable man would believe to
be inappropriate, or illegal activity that the entity has brought to the attention of the
pharmacy owner or corporate headquarters of the pharmacy.
Present law also provides that health insurance issuers that limit the period of time that a
pharmacist or pharmacy under contract for delivery of covered benefits has to submit claims
for payment pursuant to specific claims submission standards shall have the same limited
period of time following payment of such claims to perform any review or audit for purposes
of reconsidering the validity of such claims.
Proposed law eliminates this conflict in present law by providing that present law relative
to reviews or audits made pursuant to certain claims submission standards shall not apply
to present law relative to onsite audits of the records of a pharmacy.
Proposed law provides that it shall apply only to contracts entered into, amended, extended,
or renewed on or after January 1, 2017.
(Amends R.S. 22:1856(B))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.