Posts Tagged: TPA

IROs – Relief or Confusion?

in Affordable Care Act

Late Tuesday, DOL released FAQs regarding various miscellaneous ACA issues.  DOL also released additional guidance on the claims and appeals procedures in Technical Release 2010-02.   THe FAQs can be seen here: http://www.dol.gov/ebsa/faqs/faq-aca.html The FAQs are a strange aggregation of items.  One of the FAQs states that with respect to IRO contracts that the earlier DOL guidance never required a contract between a plan and an IRO.  This is in direct contradiction with Technical Release 2010-01 which specifically states that a contract between a plan and an IRO must contain specific language as set forth in the release.  If a contract… Continue Reading

Significant Changes for Appeal Rules and EOBs

in Affordable Care Act

Previously, on July 23, 2010, DOL, HHS and Treasury issued interim final rules regarding the claim and appeal requirements under the Affordable Care Act.  These new requirements will apply to all non-grandfathered plans beginning January 1, 2011 (for calendar year plans).  Yesterday, DOL updated the rules by releasing two additional pieces of guidance – new Federal external appeal rules for self-insured plans and model notices for all plans. The Federal external appeal rules are contained in Technical Release 2010-01 and require self-insured plans to follow a new mandatory external appeal process, once participants complete the internal claim and appeal process. DOL also issued three model notices… Continue Reading