Attorneys & Professionals
External Review of Denied Appeals
One of the mandates under the Patient Protection and Affordable Care Act (ACA) is that non-grandfathered health plans must adopt new standards for claims and appeals and provide external review of denied appeals. Regulations issued July 23, 2010 (and summarized in a Vorys Client Alert available at http://www.vorys.com/healthcarereform) spelled out stringent new requirements for claims and appeals, but included only a general framework for external review of denied appeals under self-insured health plans. The Department of Labor (DOL) has now issued Technical Release 2010-01 (available at http://www.dol.gov/ebsa/healthreform//) creating a safe harbor interim external review process.
Click on the link below to download the Labor and Employment Alert which discusses this review process.