A Louisiana bill introduced Tuesday would establish a statewide workers compensation medical claims database and overhaul how provider reimbursements are calculated.
S.B. 408 would require Louisiana Works, the state’s workers compensation administration, to create and maintain an “All Workers’ Compensation Medical Claims Database” containing medical and pharmacy claims submitted by all payors in the state. The database is intended to improve transparency in reimbursement trends, monitor utilization and outcomes, and help detect fraud and system inefficiencies.
Beginning Jan. 1, 2027, insurers and other payors would be required to submit detailed claims data, including billing amounts, payments, procedure codes and utilization review actions, on a quarterly basis. The information would be confidential and exempt from public records laws, with penalties for unauthorized disclosure.
The measure also revises the state’s medical fee schedule, setting most professional service reimbursements at the 75th percentile of a national medical fee directory and prohibiting “by report” billing for services without established rates. Hospital and surgical reimbursements would be tied to data drawn from the new database.
Annual changes to reimbursement categories would generally be capped at 5% unless certain conditions are met, including evidence of access-to-care issues and legislative approval.
The bill further imposes stricter timelines and penalties on payors. Medical bills submitted electronically would have to be paid within 30 days, with fines of up to $5,000 per violation — and higher penalties for willful noncompliance — for late payments.
In addition, the proposal would require electronic submission of all medical bills beginning Oct. 1, 2026, and establish deadlines for prior authorization decisions, with missed deadlines deemed approvals.
The legislation directs regulators to use database data to develop an updated fee schedule and a medical quality and outcomes program aimed at improving return-to-work results and treatment effectiveness.
The bill would take effect upon the governor’s signature.