Heads up. You’ll probably want to have HR and Benefits review your health plan’s medical claims review process.
Reason: The Obama Administration just released the interim final regulations on the internal and external appeals processes for health claims, which take effect on Sept. 21, 2010.
The regs require health plans and insurers to create a comprehensive claims appeals process for patients who appeal any decisions on services, coverage and claims payments.
While the existing rules for ERISA-covered plans still remain in effect, the new regs expand the requirements, so they now apply to insurers.
In addition, the regs also add six new elements for all plans and insurers.
Note: Under the reform law, the interim finals regs do not apply to grandfathered plans — plans that existed as of March 23, 2010, the day the reform law went into effect.
For more info on the regs and the list of six new elements, click.
