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.
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)