§460.72. Medicaid managed care organization provider notice

A. Each Medicaid managed care organization shall comply with the following notice provisions regarding contracted provider status and ability to begin providing services and submitting claims for reimbursement:

(1) Any Medicaid managed care organization that contracts with or enrolls a provider into its provider network shall furnish written notice to the provider that informs the provider of the effective date of the contract and enrollment.

(2) Unless otherwise authorized by law, a provider shall not submit Medicaid reimbursement claims for any services provided prior to the effective date indicated in the written notice.

(3) The Medicaid managed care organization shall send the written notice required in this Subsection to the last mailing address and last email address submitted by the provider.

B. Each Medicaid managed care organization shall comply with the following notice provisions regarding contracted provider re-credentialing:

(1) Each Medicaid managed care organization shall provide a minimum of three written notices to a contracted provider with information regarding the re-credentialing process, including requirements and deadlines for compliance. The first notice shall be issued by the Medicaid managed care organization no later than six months prior to the expiration of the provider's current credentialing. The notice shall include the effective date of termination if the provider fails to meet the requirements and deadlines of the re-credentialing process.

(2) The Medicaid managed care organization shall send the written notices required in this Subsection to the last mailing address and last email address submitted by the provider.

(3) If the provider fails to timely submit all required documents and meet all re-credentialing requirements, the Medicaid managed care organization shall send a termination notice to the provider with an effective date of termination to be fifteen days after the date of the notice. The Medicaid managed care organization shall send the termination notice via certified mail to the provider's last mailing address as submitted by the provider. The Medicaid managed care organization shall be responsible for paying any claims for services delivered prior to the termination date specified in the notice.

C. If a Medicaid managed care organization terminates a provider and removes a provider from its provider network for reasons other than failure to comply with the re-credentialing process set forth in Subsection B of this Section, the Medicaid managed care organization shall send written notice of the termination via certified mail to the last known mailing address submitted by the provider. The termination notice shall include the effective date of the termination. The termination date shall be fifteen days from the date of the notice if the termination is pursuant to R.S. 46:460.73(A). The termination shall be immediate if the termination is pursuant to R.S. 46:460.73(B) or due to the loss of required license.

D. A provider shall give written notice of any change in licensure or accreditation status to each Medicaid managed care organization with which it is contracted or enrolled in a provider network. The provider shall furnish such written notice to the Medicaid managed care organization within two business days of the provider's knowledge of the change.

Acts 2018, No. 489, §1.