Healthcare Reform: How to Interpret the New Internal & External Appeals Regulations
In this webinar AllMed covers how the Patient Protection and Affordability Care Act has added new regulations on how to handle internal and external appeals.
Before hastily interpreting the new provisions of Section 2719 of the Patient Protection and Affordable Care Act and implementing new processes that may not be necessary, payer organizations should realize that most of them will generally be compliant with their existing internal appeals process and will not need to make any changes.
The requirement to implement a new federal external review process applies only to plans in the small number of states without existing regulations. Other plans can comply by voluntarily participating in their state external review processes or by implementing federal processes. The requirement to contract with at least three URAC-accredited independent review organizations (IROs) only applies to the external review process, and contracts for internal appeal processes require no change. It is important to keep all of this in mind when sifting through the voluminous legislation documentation.
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