§460.84. Costs

A. The fee for conducting an independent review shall be paid to the independent reviewer by the managed care organization; except that for reviews conducted in accordance with R.S. 46:460.90, a dental coordinated care network shall pay the fee for an independent review to the Louisiana State University School of Dentistry. A provider shall, within ten days of the date of the decision of the independent reviewer, reimburse a managed care organization for the fee associated with conducting an independent review when the decision of the managed care organization is upheld. If the provider fails to submit payment for the independent review within ten days from the date of the decision, the managed care organization may withhold future payments to the provider in an amount equal to the cost of the independent review; however, the managed care organization shall ensure that such a withholding is clearly delineated on the remittance advice. If a provider fails to properly reimburse the managed care organization, the department may prohibit that provider from future participation in the independent review process.

B. The managed care organization shall compensate the independent reviewer within thirty calendar days of receipt by the managed care organization of the reviewer's bill for services rendered. If the managed care organization fails to pay the bill for the independent reviewer's services, then the reviewer may request payment directly from the department from any funds held by the state that are payable to the managed care organization.

C. The fee for an independent review of a dental claim conducted in accordance with R.S. 46:460.90 shall be paid in an amount established in a contract or memorandum of understanding between the department and the Louisiana State University School of Dentistry.

Acts 2017, No. 349, §2; Acts 2018, No. 284, §1.