The Obama Administration released interim final regulations aimed at creating a system of checks and balances for the internal and external appeals processes of health claims.
Governed by the Patient Protection and Affordable Care Act, the interim final rule requires group health plans and insurers to establish a comprehensive appeals process for patients who appeal decisions on coverage, services and claim payments. The interim final regulations apply to self-funded health plans, but not to grandfathered plans under the PPACA.
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