Federal agencies have developed examples of the notices that health plans and health insurers will need to send to implement new federal Affordable Care Act internal and external appeals rules.
The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), will set minimum standards for benefits determination reviews nationwide.
The rules create standards both for internal reviews and independent external reviews.
The Employee Benefits Security Administration is representing the U.S. Labor Department in efforts to develop review standards, and the new federal Office of Consumer Information and Insurance Oversight (OCIIO) is representing the U.S. Department of Health and Human Services.
EBSA has posted a description of federal external revenue procedures and 3 model notices on its website.