Louisiana requires workers’ compensation claims reporting and electronic medical billing

Louisiana’s office of workers’ compensation administration must maintain a database of medical and pharmacy claims. All workers’ compensation payers in Louisiana must report claims data, including charges, payments, and treatment codes. They must cooperate with authorized audits of data accuracy. Records must remain confidential and be used only for the listed oversight purposes. Public reports must combine records or remove identifying details. Reporting violations may bring fines up to $500 per day after written notice and a chance to comply. The office may allow more time for good cause and consider reasons for noncompliance. Willful violations may bring an additional penalty up to $10,000 per day. Refusing to cooperate with a data audit may bring fines up to $10,000 per day. Confidentiality violations carry a misdemeanor fine up to $500 per offense. Knowingly using, selling, or transferring confidential data for gain or malicious harm may bring a penalty up to $50,000 per violation. Reporting begins January 1, 2027, and is quarterly unless rules governing the medical payment schedule require otherwise.

Medical providers must bill electronically. Louisiana’s workers’ compensation office must also run a program that measures care quality and workers’ recovery. These requirements cover medical bills for Louisiana workers’ compensation claims and care provided to injured employees. Payers must review electronic claims within five business days and report all known defects or reasons for not accepting them. A provider’s claim counts as submitted on time if the required notice of defects or reasons for rejection is not given. The office may operate an online system for requesting treatment approval and may test it with selected areas or payers before statewide use. The care-quality program must track measurable results, which may include return to work, recovery, and time spent receiving treatment. Electronic billing begins July 1, 2027. The care-quality program must be implemented no later than January 1, 2031.

Louisiana’s workers’ compensation office must use state claims data to prepare updated limits on medical payments. The payment schedule covers medical care for injured workers. The office must publish its methods and consider access to care, payment patterns, and treatment use. Section 5 says a revised payment schedule cannot take effect unless the legislature approves it and the governor signs it. Current payment rules continue until a revised schedule is adopted and formally issued. If a schedule has not been adopted and implemented on or before July 1, 2029, Section 10 requires the office to issue rules for a schedule based on usual charges drawn from the database. The required report to lawmakers is informational. It does not itself set payment limits or authorize their enforcement. Formal rulemaking must begin no later than July 1, 2029. An informational report is due no later than 30 days before the 2029 legislative session begins.

Employers and claim payers must send benefit notices and follow the rules for an early hearing on a benefit dispute. These procedures cover wage-replacement payments and medical benefits. They exclude disputes about whether treatment is needed or how much a medical provider should be paid. Notices may be sent by certified mail, commercial carrier, email, or hand delivery. A represented worker’s attorney must also receive notice. Paying the demanded benefit and overdue amounts within ten business days protects the employer or payer from penalties and attorney fees arising from that dispute. Workers may file a disputed claim sooner if their filing deadline falls within the waiting period. The payer still has ten business days to provide the benefit. A payer requesting an early hearing must disclose supporting records within ten business days. A worker must object within 21 business days after receiving those records or lose the right to object to that hearing. Initial-payment notices are due within three business days after payment. Early hearings are generally due within 90 days of the scheduling conference, with one approved 30-day extension for good cause. Decisions are due within 15 days after the hearing.

Section 1 sets treatment-approval and medical payment rules. Its billing-dispute process requires state review and allows the losing party to appeal. These rules cover workers’ compensation treatment requests, medical bills, and billing disputes involving providers, workers, employers, or claim payers. Implant payments are set at the manufacturer’s or authorized distributor’s invoice amount paid plus 20%. Section 6 makes Section 1 effective only when lawmakers approve the updated payment schedule. Section 7 separately says the billing-dispute provisions take effect no later than January 1, 2029. Properly submitted requests for office visits, diagnostic tests, or up to twelve chiropractic or physical therapy visits count as approved unless specifically denied within five business days. After five business days without a denial of nonsurgical treatment, a provider may request a state approval order. The director must verify proper submission and issue the order within five business days of receiving the notice. The losing party pays review costs. An order requiring payment of a denied claim carries 12% annual interest from the denial date. The losing party may appeal to district court within 30 days after receiving the decision by certified mail. Complete electronic medical bills are payable within 30 days of receipt. Billing decisions are due within 15 business days of submission. Rules and forms for the dispute process are due no later than January 1, 2028.