Louisiana Administrative Code
Title 32 - EMPLOYEE BENEFITS
Part I - General Provisions
Chapter 5 - Uniform Provisions-Plan Administration
Section I-505 - Automated Claims Adjusting
Universal Citation: LA Admin Code I-505
Current through Register Vol. 50, No. 9, September 20, 2024
A. Any OGB plan of benefits may utilize commercially licensed software that applies all claims against its medical logic program to identify improperly billed charges and charges for which an OGB plan of benefits provides no benefits. Any claim with diagnosis or procedure codes deemed inadequate or inappropriate will be automatically reduced or denied. Providers accepting assignment of benefits cannot bill the plan participant for the differential on the denial amount, in whole or in part.
AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
