§460.76. Prepayment review

            A. A managed care organization or a contractor, assignee, agent, or entity acting on the behalf of a managed care organization shall be prohibited from requiring any enrolled provider to be subject to prepayment review unless the requirement is implemented directly by the department and in accordance with the provisions of the Medical Assistance Programs Integrity Law, R.S. 46:437.1 et seq.

            B. For the purposes of this Section, "prepayment review" means any action by a managed care organization or a contractor, assignee, agent, or entity acting on the behalf of a managed care organization requiring a healthcare provider to provide medical record documentation in conjunction with or after the submission of a claim for payment for medical services rendered, but before the claim has been adjudicated by the managed care organization.

            C.(1) Nothing in this Section shall prohibit a managed care organization from notifying the department of healthcare providers suspected of committing fraud and abuse.

            (2) Nothing in this Section shall prohibit the department from requiring all managed care organizations to coordinate efforts to combat and prevent fraud and abuse pursuant to any requirements ordered by the department in accordance with the Medical Assistance Programs Integrity Law, R.S. 46:437.1 et seq.

            D. The provisions of this Section shall not apply to any dental coordinated care network as defined in R.S. 46:460.51.

            Acts 2022, No. 534, §1.