The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERIS...(r /3.   Sec. 233 of the A...),Health

Date:11/9/2009

r /> 3.   Sec. 233 of the Act, Requiring Information Transparency and Plan Disclosure, enhanced the existing ERISA disclosure obligations for the plan and insurance company, and requires "Accurate and Timely Disclosure", for both exchange participating health benefit plans and employment-based health plans, to both Health Choices Commissioner and the public, doctors, hospitals and the patients, of plan documents, plan terms and conditions, claims payment policies, and practices, periodic financial disclosure, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information.
4.   Sec. 233 (5) of the Act, Cost-Sharing Transparency, requires the plan to disclose to the healthcare provider the real fee schedule, plan UCR limit for individual service and supplies at CPT & HCPCS code level.
5.   Sec. 235 of the Act, Timely Payment of Claims, provides new federal "Prompt Pay" laws, based on Medicare Part C timeframe, Managed-Care Medicare, to comply with the requirements of section 1857(f) of the Social Security Act.
6.   Sec. 238 of the Act, State Prohibitions on Discrimination against Health Care Providers, has adopted "Any Willing Provider Laws" from existing state laws.
7.   Sec. 251 of the Act provides new consumer protections, or Obama Patient Bill Of Rights, with state law compensatory and punitive damages as remedies for exchange-participating health plan members, although the new law does not change ERISA preemption of state punitive damage remedies (License to Kill, as some referred to) for employment-based health plans (traditional ERISA plans).
8.   Sec. 257 of the Act allows state attorney general to sue for the compensatory and punitive damages on behalf of the private citizen of the state for any vi
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