LAC 50:I.1517 – Managed Care Organization Payment Accountability and Provider Credentialing

A. All managed care organizations (MCOs) participating in the Medical Assistance Program must comply with all requirements described in R.S. 46.460.72 and R.S. 46:460.73, which pertain to provider notices and payment accountability.
B. A provider who receives a notification of deficiency from a Medicaid MCO as described in R.S. 46:460.73(A)(1) may seek review of the matter to the department if the conditions of R.S. 46:460.73(A)(2) apply. The provider must notify the department of their intent to appeal the notification within 10 calendar days of the date of the MCO’s notification and provide a detailed request for departmental review with supporting documents within 15 calendar days of the date of the MCO’s notification.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 50:981 (July 2024).