La. Admin. Code tit. 32 § I-501
Current through Register Vol. 50, No. 11, November 20, 2024
A. To obtain the highest level of benefits available, the plan participant should always verify that a provider is a current network provider in the enrollee's plan of benefits before the service is rendered.B. For OGB plan of benefits reimbursements, a claim shall include: 3. name, address, and telephone number of the provider of care;5. type of services rendered, with diagnosis and/or procedure codes that are valid and current for the date of service;6. date and place of service;8. enrollee's plan of benefits identification number;9. provider tax identification number;10. Medicare explanation of benefits, if applicable.C. OGB or its agent may require additional documentation in order to determine the extent of coverage or the appropriate reimbursement. Failure to furnish information within the time period allowed by the respective OGB plan of benefits may constitute a reason for the denial of benefits.D. A claim for benefits, under any self-funded plan of benefits offered by OGB shall be received by the enrollee's plan of benefits within one year from the date on which the medical expenses were incurred. The receipt date for electronically filed claims is the date on which the enrollee's plan of benefits receives the claim, not the date on which the claim is submitted to a clearinghouse or to the provider's practice management system.E. Requests for review of payment or corrected bills shall be submitted within 12 months of receipt date of the original claim. Requests for review of payment or corrected bills received after that time will not be consideredLa. Admin. Code tit. 32, § I-501
Promulgated by Office of the Governor, Division of Administration, Office of Group Benefits, LR 41:345 (February 2015), effective March 1, 2015.AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).