ERISA COMPLIANCE

The new ERISA Claims Regulations, which took effect for all employer sponsored health plans on January 1, 2003, place another layer of administrative responsibility on employers, especially those with self-funded health plans. Claim decisions (both pre-service and post-service) must be made under more stringent timeframes and appeal procedures are more complicated, involving increased legwork by the employer. Appeals that include medical determinations must involve a consult with a qualified health care professional. Failure to strictly follow these procedures will open the employer/plan sponsor to potential lawsuits.
Outsourcing Appeals Management Services allows self-funded health plans to utilize experienced plan appeals experts with a network of qualified medical professionals. In light of the new HIPAA privacy regulations, outsourcing the appeals management will also help ensure that the plan member’s health information is properly protected as required under the regulations.
MAM is the solution for the self-funded plan to properly handle the management of its internal appeals process with qualified experts.

For information on HIPAA complaince, click here.