HLS 20RS-707 ORIGINAL
2020 Regular Session
HOUSE BILL NO. 195
BY REPRESENTATIVE DUSTIN MILLER
INSURANCE CLAIMS: Provides for the payment of health insurance claims prior to the
credentialing of a healthcare provider
1 AN ACT
2To amend and reenact R.S. 22:1874(A)(5)(a)(ii), relative to the payment of claims made by
3 healthcare providers prior to credentialing; to repeal the requirement that a healthcare
4 provider submit proof of active hospital privileges; to provide for an effective date;
5 and to provide for related matters.
6Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 22:1874(A)(5)(a)(ii) is hereby amended and reenacted to read as
8follows:
9 ยง1874. Billing by contracted healthcare providers
10 A.
11 * * *
12 (5)(a) Under certain circumstances and when the provisions of Subparagraph
13 (b) of this Paragraph are met, a health insurance issuer contracting with a group of
14 healthcare providers that bills a health insurance issuer utilizing a group
15 identification number, such as the group federal tax identification number or the
16 group National Provider Identifier as set forth in 45 CFR 162.402 et seq., shall pay
17 the contracted reimbursement rate of the provider group for covered healthcare
18 services rendered by a new provider to the group, without healthcare provider
19 credentialing as described in R.S. 22:1009. This provision shall apply in either of
20 the following circumstances:
21 * * *
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 20RS-707 ORIGINAL
HB NO. 195
1 (ii) When the health insurance issuer has received the required credentialing
2 application and information, including proof of active hospital privileges, from the
3 new provider and the issuer has not notified the provider group that credentialing of
4 the new provider has been denied.
5 * * *
6 Section 2. This Act shall become effective upon signature by the governor or, if not
7signed by the governor, upon expiration of the time for bills to become law without signature
8by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
9vetoed by the governor and subsequently approved by the legislature, this Act shall become
10effective on the day following such approval.
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 195 Original 2020 Regular Session Dustin Miller
Abstract: Removes the requirement to submit proof of active hospital privileges for a new
healthcare provider in a group practice who bills an insurer using the group practice's
identification number prior to credentialing.
Present law requires, under certain circumstances, a health insurance issuer contracting with
a group of healthcare providers that bills the health insurance issuer using a group
identification number to pay the contracted reimbursement rate of the provider group for
covered healthcare services rendered by a new provider to the group without healthcare
provider credentialing in either of the following circumstances:
(1)The new provider has already been credentialed by the health insurance issuer and
the provider's credentialing is still active with the issuer.
(2)The health insurance issuer has received the required credentialing application and
information, including proof of active hospital privileges, from the new provider and
the issuer has not notified the provider group that credentialing of the new provider
has been denied.
Proposed law retains present law but removes the requirement that the new provider submit
proof of active hospital privileges.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1874(A)(5)(a)(ii))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.