In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...more
On April 11, 2024, the U.S. Court of Appeals for the Ninth Circuit, in Ryan S. v. UnitedHealth Group, Inc., set a very broad pleading standard to allege a violation of the Paul Wellstone and Pete Domenici Mental Health Parity...more
The key takeaway from Graham Contracting, Ltd v. City of Federal Way in Washington appeals court - A recent unpublished decision issued by the Court of Appeals of Washington, Graham Contracting, Ltd v. City of Federal...more
Following notification of impact to a property through the claims notification process, restorers are regularly called upon to make necessary initial decisions regarding water extraction and drying and impacted material...more
We previously discussed the Internal Revenue Service’s (IRS) efforts to adjust to a remote environment by offering video meetings and secure messaging systems in order to maintain an efficient audit process. We also...more
The North Carolina Insurance Department (“Department”) recently announced a regulatory action against an insurer for alleged claims practices violations and contracting with a TPA before it became licensed in North Carolina....more
Do Reps and Warranties Insurers Pay Claims? Yes–With Caveats, New Survey Finds- During the last decade, intense deal activity spurred the growth of R&W insurance–an alternative risk-transfer mechanism to indemnify buyers...more
Insurance providers, particularly in the property and casualty sector, are under the same pressures as other businesses: They need to speed up cycle times in handling claims, cut expenses, and improve customer experiences. ...more
On April 30, 2020, the Internal Revenue Service and the Department of Labor extended certain time frames for special enrollment in a health plan, COBRA coverage, claims procedures, and external reviews for all welfare and...more
The digitization of business is in high gear. Although some sectors have embraced this change, others, including the insurance industry, have been slower to implement advances. While we’ve previously addressed insurance...more
On July 30, 2019, the Centers for Medicare & Medicaid Services (CMS) announced “Data at the Point of Care” (DPC), a pilot program that will provide clinicians with access to claims data. The pilot program follows on the heels...more
Drinker Biddle is pleased to present you with this recap—or “a slice” of the 2019 ILTCI Conference, Chicago, Illinois. Year after year, the ILTCI Conference is jam-packed with opportunities to reconnect with and learn from...more
On February 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 3971 (Change Request 10412), which revises a section of the Medicare Claims Processing Manual (Manual), that provides guidance...more
Seyfarth Synopsis: The ordinary headaches of responding to unemployment claims with the EDD do not have to bog down employers in 2018. Here, we provide recommendations for managers to consider before the ball drops in Times...more
In a unanimous decision, the U.S. Supreme Court ruled today that a federal procedural rule that allows a district court to extend an appeal deadline by no more than 30 days is a non-jurisdictional, mandatory claims processing...more
Two of the nation’s most noteworthy companies in the Revenue Cycle Management (“RCM”) technology space, Navicure Inc., and ZirMed Inc., announced a merger on September 14, 2017....more
On October 6, 2017, the Department of Labor signed a proposed Rule “to delay for ninety (90) days – through April 1, 2018 – the applicability of the Final Rule amending the claims procedure requirements applicable to...more
The National Gallery London hosted on September 12, 2017 the much-anticipated conference “70 Years and Counting: the Final Opportunity?” organized by the United Kingdom Department for Digital, Culture Media & Sport (DCCS),...more
When coverage is at issue, the interplay between a policy’s language and an insurer’s duties under the Claims Administration Statute, Florida Statute Section 627.426, becomes a key factor in claims handling for insurers. In...more
The Department of Labor’s (DOL) Employee Benefits Security Administration has issued final regulations that change the claims and appeals procedures for disability benefits provided by ERISA plans. The final rules are...more
CMS recently reminded providers that Medicare claims with a date of service on or after October 1, 2015, “will be rejected if they do not contain a valid ICD-10 code.” As CMS explained, “[t]he Medicare claims processing...more
In a recently enacted budget measure, Connecticut has moved one step closer to implementing statewide paid family and medical leave for employees. However, details about funding and the extent of coverage that any ultimately...more
On December 5, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule titled “Requirements for Medicare Incentive Reward Program and Provider Enrollment” (“the Rule”). The Rule implemented several...more