Health Care Reform – Significant New Changes to Claims and Appeals Requirements

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As summarized in a previous FR Alert, non-grandfathered group health plans are subject to new claims and appeals requirements under the Patient Protection and Affordable Care Act, as modified by the Health Care and Education Reconciliation Act of 2010. In July and August of 2010, the Departments of Treasury, Labor, and Health and Human Services (the “Agencies”) issued interim final regulations and other guidance regarding these new requirements. On June 24, 2011, the Agencies released an amendment that significantly changes many of the original requirements in the interim final rules.

The following is a summary of the significant changes made to the interim final rules:

Deadline for Notification of Urgent Care Determinations Lengthened to 72 Hours

The interim final rules shortened the deadline for providing determinations of urgent care claims from 72 hours to 24 hours. The amendment eliminates this change, and retains the current requirement that urgent care claims must be decided as soon as possible but not later than 72 hours. The preamble to the amendment does, however, say that the 72-hour deadline is an outside limit and some claims may have a shorter deadline based on the medical exigencies involved.

Please see full article below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Franczek Radelet P.C. | Attorney Advertising

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