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The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERISAclaim.com
Date:11/9/2009

signed into law as to the antitrust provision of H. R. 3962 and whether the government or insurance companies will collect and manage the mandatory insurance premiums, it is absolutely clear that a new federal claim regulation will be signed into law, as passed by the House of Representatives. ERISA claim regulation, 29 CFR 2560.503-1, will be statutorily incorporated in its entirety into the new law for all qualified health benefit plans (QHBP), as the most important provisions from H. R. 3962 for healthcare providers for reimbursement purposes. The Affordable Health Care for America Act will create a new federal agency, Health Choices Administration, regulating qualified health benefit plans (QHBP), consisting of employment-based health plans, the traditional voluntary ERISA plans, and health insurance exchange plan, the new mandatory ERISA plans. The new legislation, H.R. 3962, is significant with following provisions:

1.   Sec. 232 (b) of the Act, Requiring Fair Grievance and Appeals Mechanisms of the Act provides: "(b) INTERNAL CLAIMS AND APPEALS PROCESS.--Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims) set forth at section 2560.503-1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70246) and shall update such process in accordance with any standards that the Commissioner may establish".
2.   Sec. 232 (c) of the Act also creates a new federal external review process based on ERISA claim regulation to provide for an impartial, independent, and de novo review of denied claims, and the Health Choices Commissioner's decision shall be binding on the plan and the entity, as the final claim decision in absence of judicial reviews, which is available now for punitive damages for exchange participating health plans. '/>"/>

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