™Your Policy Risk Impact Agent
0 chapters · 1,747 sections in this title.
La. Rev. Stat. § 22:1808.6 Exemption from examination
1.7K chars
§1808.6. Exemption from examination A. An individual who applies for an insurance consultant license in this state who was previously licensed as a resident insurance consultant for the same lines of authority in another state shall not be required to complete an examination. Thi…
La. Rev. Stat. § 22:1808.7 Assumed names
1.1K chars
§1808.7. Assumed names A. An insurance consultant doing business under any name other than the consultant's legal name is required to notify the commissioner of insurance prior to using the assumed name. Prior to the use of or changes to any trade name or names, an insurance cons…
La. Rev. Stat. § 22:1808.8 License denial, suspension, nonrenewal, or revocation
8.5K chars
§1808.8. License denial, suspension, nonrenewal, or revocation A. The commissioner of insurance may place on probation, suspend, revoke, or refuse to issue, renew, or reinstate an insurance consultant license, or may levy a fine not to exceed five hundred dollars for each violati…
La. Rev. Stat. § 22:1808.9 Commissions
1.9K chars
§1808.9. Commissions A. No person or business entity licensed and acting as an insurance consultant under a written agreement pursuant to R.S. 22:1808.11, shall accept any commission, service fee, brokerage, or other valuable consideration for selling, soliciting, or negotiating …
La. Rev. Stat. § 22:181 Reserves
0.5K chars
§181. Reserves Each reciprocal insurer subject to this Subpart shall maintain the same reserves, calculated in the same manner and upon the same basis as the reserves required to be maintained by stock and mutual insurers transacting the same kind or kinds of insurance. Acts 1958…
La. Rev. Stat. § 22:1811 Payment of claims; life policies; penalty
0.7K chars
§1811. Payment of claims; life policies; penalty All death claims arising under policies of insurance issued or delivered within this state shall be settled by the insurer within sixty days after the date of receipt of due proof of death, and if the insurer fails to do so without…
La. Rev. Stat. § 22:182 Amendment of declaration of organization
1.1K chars
§182. Amendment of declaration of organization The attorney-in-fact of any domestic reciprocal insurer upon written approval of at least a majority of the subscribers, may amend the declaration of organization of such insurer in any respect not in violation of law, but the declar…
La. Rev. Stat. § 22:1821 Payment of claims; health and accident policies; prospective review; penalties;
16.8K chars
§1821. Payment of claims; health and accident policies; prospective review; penalties; self-insurers; telehealth reimbursement by insurers; prohibitions A. All claims arising under the terms of health and accident contracts issued in this state, except as provided in Subsection B…
La. Rev. Stat. § 22:1822 Proceeds from health care payments; notice to patient, creditor
1.2K chars
§1822. Proceeds from health care payments; notice to patient, creditor A. Any entity, including a health care provider as defined by R.S. 40:1231.1, receiving health insurance payments from a health insurer or other payor of health care benefits shall provide written notice to th…
La. Rev. Stat. § 22:1823 Hospitalization insurance, exclusion of payments to medical facilities owned or operated by state or for services reimbursed by medical assistance
1.4K chars
§1823. Hospitalization insurance, exclusion of payments to medical facilities owned or operated by state or for services reimbursed by medical assistance A. No policy of hospitalization insurance shall be issued after August 31, 1968, by any insurer doing business in this state w…
La. Rev. Stat. § 22:1824 Uniform claim forms; promulgation, implementation
1.4K chars
§1824. Uniform claim forms; promulgation, implementation A. The Department of Insurance shall promulgate rules and regulations for the establishment of uniform claim forms, in both written form and by electronic means, for all hospital, health, or medical expense insurance polici…
La. Rev. Stat. § 22:1825 Billing audit guidelines, rules, and regulations
2.0K chars
§1825. Billing audit guidelines, rules, and regulations A. The commissioner shall, with the consent of the Louisiana Department of Health and in compliance with the Louisiana Administrative Procedure Act, issue such rules, regulations, and orders as shall be necessary to implemen…
La. Rev. Stat. § 22:1826 Payment of claims for emergency services provided by noncontracted health care providers
1.5K chars
§1826. Payment of claims for emergency services provided by noncontracted health care providers A. If a health care provider that does not contract with a health insurance issuer files a claim with a health insurance issuer for emergency services rendered, the health insurance is…
La. Rev. Stat. § 22:1827 Submission of health insurance claims
1.5K chars
§1827. Submission of health insurance claims A. No healthcare provider that accepts a patient's health insurance coverage shall require an enrollee or insured to consent to payment for healthcare services as a condition for verification of health insurance coverage for such healt…
La. Rev. Stat. § 22:1828 Provider claim payment and information protection
3.7K chars
§1828. Provider claim payment and information protection A. As used in this Section: (1) "Electronic funds transfer" means an electronic funds transfer through the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended, standard automated cl…
La. Rev. Stat. § 22:183 Application for receiver
0.5K chars
§183. Application for receiver No proceedings for the dissolution of, or the appointment of a receiver for, any domestic reciprocal insurer shall be entertained by any court in this state unless the same is made by the commissioner of insurance in accordance with R.S. 22:73, 96, …
La. Rev. Stat. § 22:1831 Definitions
10.7K chars
§1831. Definitions As used in this Subpart, the following terms shall be defined as follows: (1) "Accepted claim" means either of the following: (a) A nonelectronic claim on a HCFA 1500 form or Uniform Billing Form 92 (UB92), properly completed according to Medicare guidelines. (…
La. Rev. Stat. § 22:1832 Standards for receipt and processing of nonelectronic claims
3.9K chars
§1832. Standards for receipt and processing of nonelectronic claims A.(1) Any nonelectronic claim by a health care provider under a contract with a health insurance issuer, for provision of health care services, submitted by the provider or its agent within forty-five days of the…
La. Rev. Stat. § 22:1833 Standards for receipt and processing of electronic claims
4.2K chars
§1833. Standards for receipt and processing of electronic claims A.(1) A health insurance issuer shall allow a health care provider access to information in the issuer's Payer's Companion Guide, or its successor, listing issuer-specific data requirements for accepted electronic c…
La. Rev. Stat. § 22:1834 Remittance advice; thirty-day payment standard; limitations on claim filing and audits
3.3K chars
§1834. Remittance advice; thirty-day payment standard; limitations on claim filing and audits A. Each remittance advice generated by a health insurance issuer or its agent to a health care provider or its agent shall include the following information, if known at that time, clear…
La. Rev. Stat. § 22:1835 Regulations; applicability
0.9K chars
§1835. Regulations; applicability A. The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Subpart. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure A…
La. Rev. Stat. § 22:1836 Coordination of benefits
1.7K chars
§1836. Coordination of benefits A. Coordination of benefits requirements adopted by health insurance issuers shall, at a minimum, adhere to the following requirements: (1) No plan shall contain a provision that its benefits are "always excess" or "always secondary" except in acco…
La. Rev. Stat. § 22:1837 Violations; cease and desist orders; penalties
2.5K chars
§1837. Violations; cease and desist orders; penalties A. Whenever the commissioner has reason to believe that any health insurance issuer is not in full compliance with the requirements of this Subpart, the commissioner shall notify such issuer in accordance and compliance with R…
La. Rev. Stat. § 22:1838 Recoupment of health insurance claims payments
3.5K chars
§1838. Recoupment of health insurance claims payments A. As used in this Section, "recoupment" shall mean a reduction, offset, adjustment, or other act to lower or lessen the payment of a claim or any other amount owed to a health care provider for any reason unrelated to that cl…
La. Rev. Stat. § 22:184 Penalties
0.5K chars
§184. Penalties No person shall act as attorney-in-fact for a reciprocal insurer except in accordance with the provisions of this Subpart and any person who violates any of the provisions of this Section or who knowingly participates in or abets such violation shall be guilty of …
La. Rev. Stat. § 22:1841 Definitions
2.1K chars
§1841. Definitions For purposes of this Subpart, the following definitions apply: (1) "Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a h…
La. Rev. Stat. § 22:1842 Telehealth healthcare services statement
0.8K chars
§1842. Telehealth healthcare services statement A.(1) Each issuer of a health coverage plan shall display in a conspicuous manner on the health coverage plan issuer's website information regarding how to receive covered telehealth healthcare services and remote patient monitoring…
La. Rev. Stat. § 22:1843 Remote patient monitoring services
3.4K chars
§1843. Remote patient monitoring services A. The legislature hereby finds all of the following: (1) Remote patient monitoring services aim to allow more people to remain at home or in other nontraditional clinical settings and to improve the quality and cost of their care, includ…
La. Rev. Stat. § 22:1844 Exclusions
0.3K chars
§1844. Exclusions The provisions of this Subpart shall not apply to any plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months. Acts 2020, No. 276, §1, e…
La. Rev. Stat. § 22:1845.1 Telehealth coverage and reimbursement for physical therapy; prohibitions and
4.3K chars
§1845.1. Telehealth coverage and reimbursement for physical therapy; prohibitions and limitations; exceptions; rulemaking A. A health coverage plan shall pay for covered physical therapy services provided via telehealth to an insured person. Telehealth coverage and payment shall …
La. Rev. Stat. § 22:1845.2 Telehealth coverage and reimbursement for occupational therapy; prohibitions and
4.3K chars
§1845.2. Telehealth coverage and reimbursement for occupational therapy; prohibitions and limitations; exceptions; rulemaking A. A health coverage plan shall pay for covered occupational therapy services provided via telehealth to an insured person. Telehealth coverage and paymen…
La. Rev. Stat. § 22:185 Application of other sections
0.3K chars
§185. Application of other sections Except as otherwise provided in this Subpart, every reciprocal insurer shall be subject to other applicable provisions of this Code. Acts 1958, No. 125; Redesignated from R.S. 22:456 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1851 Legislative intent
0.9K chars
§1851. Legislative intent The legislature finds that making prompt and correct payment for prescription drugs, other products and supplies, and pharmacist services covered under insurance or other contracts that provide for pharmacy benefits is important to the health and welfare…
La. Rev. Stat. § 22:1852 Definitions
3.4K chars
§1852. Definitions As used in this Subpart, the following terms are defined as follows: (1) "Claim" means a request by a pharmacist for payment by a health insurance issuer. (2) "Commissioner" means the commissioner of insurance. (3) "Department" means the Department of Insurance…
La. Rev. Stat. § 22:1853 Nonelectronic claims submission
3.5K chars
§1853. Nonelectronic claims submission A.(1) Any nonelectronic claim for payment for prescription drugs, other products and supplies, and pharmacist services submitted by a pharmacist or pharmacy within forty-five days of the date of service under a contract for provision of cove…
La. Rev. Stat. § 22:1854 Electronic claim submission standards
1.9K chars
§1854. Electronic claim submission standards A. Any claim for payment for covered prescription drugs, other products and supplies, and pharmacist services submitted by a pharmacist or pharmacy to a health insurance issuer as an electronic claim that is electronically adjudicated …
La. Rev. Stat. § 22:1855 Submission to health insurance issuer
1.0K chars
§1855. Submission to health insurance issuer A. For purposes of R.S. 22:1853, a claim shall be deemed to be submitted to the health insurance issuer when a nonelectronic claim is furnished to the health insurance issuer, its agent, or any other party that makes payment directly t…
La. Rev. Stat. § 22:1856 Payment standard; limitations on claim filing and audits; remittance advice
3.1K chars
§1856. Payment standard; limitations on claim filing and audits; remittance advice A. A health insurance issuer may elect to utilize a thirty-day payment standard for compliance with R.S. 22:1853 by providing written notice to the commissioner. Such notice shall be in a form pres…
La. Rev. Stat. § 22:1856.1 Pharmacy record audits; recoupment; appeals
10.3K chars
§1856.1. Pharmacy record audits; recoupment; appeals A. As used in this Section, "entity" means 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 …
La. Rev. Stat. § 22:1857 Prescription drugs, products, and supplies; use of index
1.5K chars
§1857. Prescription drugs, products, and supplies; use of index A. Reimbursement under a contract to a pharmacist or pharmacy for prescription drugs and other products and supplies that is calculated according to a formula that uses a nationally recognized reference in the pricin…
La. Rev. Stat. § 22:1857.1 Third-party contracts with pharmacies
0.8K chars
§1857.1. Third-party contracts with pharmacies A. Notwithstanding any provision of law to the contrary, an organization that negotiates with a pharmacy or pharmacies, and an organization that represents an independent pharmacy or a group of independent pharmacies, shall provide t…
La. Rev. Stat. § 22:1858 Coordination of benefits
1.2K chars
§1858. Coordination of benefits A. Coordination of benefit requirements adopted by health insurance issuers shall, at a minimum, adhere to the following requirements: (1) No plan shall contain a provision that its benefits are "always excess" or "always secondary" except in accor…
La. Rev. Stat. § 22:1859 Recoupment of health insurance claims payments
3.3K chars
§1859. Recoupment of health insurance claims payments A. As used in this Section, "recoupment" shall mean a reduction, offset, adjustment, or other act to lower or lessen the payment of a claim or any other amount owed to a pharmacy or pharmacist for any reason unrelated to that …
La. Rev. Stat. § 22:1860 Violations; cease and desist orders; penalties
2.5K chars
§1860. Violations; cease and desist orders; penalties A. Whenever the commissioner has reason to believe that any health insurance issuer is not in full compliance with the requirements of this Subpart, the commissioner shall notify such issuer in accordance and compliance with R…
La. Rev. Stat. § 22:1860.1 Reimbursement of pharmacy provider fee; sanctions; administrative hearings
0.7K chars
§1860.1. Reimbursement of pharmacy provider fee; sanctions; administrative hearings A. It is the obligation of a health insurance issuer or its agent to reimburse a pharmacist or his agent for fees remitted by a pharmacy or pharmacist or his agent in compliance with R.S. 46:2625.…
La. Rev. Stat. § 22:1860.3 Reimbursements
2.4K chars
§1860.3. Reimbursements A. A pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager shall not reimburse a pharmacy or pharmacist in this state an amount less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benef…
La. Rev. Stat. § 22:1861 Regulations
0.4K chars
§1861. Regulations The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Subpart. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure Act. Acts 2004, No.…
La. Rev. Stat. § 22:1862 Applicability
0.3K chars
§1862. Applicability The provisions of Subpart B of Part II of this Chapter, R.S. 22:1831 et seq., shall not apply to this Subpart. Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Redesignated from R.S. 22:250.62 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1863 Definitions
4.8K chars
§1863. Definitions As used in this Subpart, the following definitions apply: (1) "Drug Shortage List" means a list of drug products posted on the United States Food and Drug Administration drug shortage website. (2) "Effective rate pricing" means any payment reduction for pharmac…
La. Rev. Stat. § 22:1864 Requirements for use of the National Drug Code by a pharmacy benefit manager
1.9K chars
§1864. Requirements for use of the National Drug Code by a pharmacy benefit manager A. Before a pharmacy benefit manager places or continues a particular NDC or Maximum Allowable Cost List, the following requirements shall be met: (1) The prescription drug to which the NDC is ass…
