HLS 23RS-865 ORIGINAL
2023 Regular Session
HOUSE BILL NO. 582
BY REPRESENTATIVE IVEY
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID: Provides relative to Medicaid
1 AN ACT
2To enact R.S. 46:460.89.1 and 460.89.2, relative to the state's Medicaid program; establishes
3 an electronic data interchange for the state's Medicaid program; to provide for
4 patient-focused treatment; to maximize the quality of care; to improve provider
5 communication and processes; to create a data repository; and to provide for related
6 matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 46:460.89.1 and 460.89.2 are hereby enacted to read as follows:
9 §460.89.1. Medicaid; Electronic Data Interchange
10 A. The Louisiana Department of Health shall develop and implement an
11 Electronic Data Interchange, hereinafter referred to as "EDI", that will serve to
12 adjudicate all fee-for-service claims for Medicaid reimbursement and process all
13 managed care encounter claims.
14 B. The EDI shall address all of the following:
15 (1) Transition claims, encounters, financial processing, management, and
16 recipient and reference data from the current fiscal agent to a modern, modular
17 solution.
18 (2) Reduce the number of claim resubmissions by improving
19 communications of claim status.
20 (3) Improve the reliability of plan encounter data.
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HB NO. 582
1 (4) Reduce claim validation processing costs in agency systems.
2 (5) Reduce agency financial staff time on manual data reentry and
3 processing.
4 (6) Separate business rules, edit, and audit processing capabilities for claims
5 and encounters.
6 (7) Eliminate remaining paper claims and associated manual processes.
7 (8) Implement an accessible and efficient unemployment insurance with
8 enhanced visibility to claim detail.
9 (9) Improve data quality and management and increase automation to
10 reconcile and update recipient information.
11 §460.89.2. Medicaid; Provider Services Module
12 A. The Louisiana Department of Health shall create and implement a
13 Provider Services Module, hereinafter referred to as "PSM", that will serve to
14 consolidate provider licensure and Medicaid enrollment and plan credentialing
15 processes into a single source.
16 B. The PSM shall include an automated tool for screening activities and
17 primary source verification to be completed in accordance with state and federal
18 statutes, policies, mandates, and the National Committee for Quality Assurance
19 guidelines, as well as industry standards.
20 C. The PSM shall perform all of the following:
21 (1) Provider application processing, which is a centralized and consolidated
22 approach to enrollment for all Medicaid provider applicants and providers desiring
23 participation in programs operated by the agencies within the Louisiana Department
24 of Health, including but not limited to fee-for-service and managed care.
25 (2) Provider eligibility, screening, and credentialing consisting of highly
26 automated and streamlined eligibility determination processes, including but not
27 limited to screening, certification, and credentialing conducted based on the
28 applicant's requested program participation.
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1 (3) Provider enrollment processing, which is a highly automated process to
2 associate eligible providers to their requested programs and the services that they are
3 authorized to provide within the program.
4 (4) Provider management and oversight activities consisting of highly
5 automated and self-service processes to monitor and support the network of
6 providers servicing Louisiana programs, including but not limited to provider
7 communications, provider performance monitoring, processing of potentially adverse
8 information regarding providers, and ongoing monitoring of providers for continued
9 enrollment.
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 582 Original 2023 Regular Session Ivey
Abstract: Establishes an electronic data interchange for the state's Medicaid program.
Proposed law requires the La. Dept. of Health (LDH) to develop and implement an
Electronic Data Interchange (EDI) that will serve to adjudicate all fee-for-service claims for
Medicaid reimbursement and process all managed care encounter claims.
Proposed law requires the EDI to address all of the following:
(1)Transition claims, encounters, financial processing, management, and recipient and
reference data from the current fiscal agent to a modern, modular solution.
(2)Reduce the number of claim resubmissions by improving communications of claim
status.
(3)Improve the reliability of plan encounter data.
(4)Reduce claim validation processing costs in agency systems.
(5)Reduce agency financial staff time on manual data reentry and processing.
(6)Separate business rules and edit or audit processing capabilities for claims and
encounters.
(7)Eliminate remaining paper claims and associated manual processes.
(8)Implement an accessible and efficient unemployment insurance with enhanced
visibility to claim detail.
(9)Improve data quality and management, increase automation to reconcile, and update
recipient information.
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 23RS-865 ORIGINAL
HB NO. 582
Proposed law requires LDH to create and implement a Provider Services Module (PSM) that
will serve to consolidate the provider licensure and Medicaid enrollment and plan
credentialing processes into a single source.
Proposed law requires the PSM to include an automated tool for screening activities and
primary source verification that must be completed in accordance with state and federal
statutes, policies, mandates, and the National Committee for Quality Assurance guidelines
as well as industry standards.
Proposed law requires the PSM to perform all of the following:
(1) Provider application processing.
(2)Provider eligibility, screening, and credentialing.
(3) Provider enrollment processing.
(4) Provider management and oversight activities.
(Adds R.S. 46:460.89.1 and 460.89.2)
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.