External Review of Appealed Claim Denials


Purpose:

To assure that health plan participants receive an impartial party’s review of a denied claim


Intent:

To minimize the number of claim denials and maximize the coverage available to an individual


Health Plans Affected by this Provision:


Year Effective: 2012
Medical Plan: Yes, unless plan is grandfathered, already in effect and not significantly changed in coverage or premium share since March 23, 2010
Dental/Vision Plan: No, if stand-alone benefit excepted from HIPAA’s portability provisions
HRA: Yes, unless stand-alone benefit excepted from HIPAA’s portability provisions
Health Care FSA: No, unless FSA is a non-excepted benefit

Document Downloads:


Document Title Last Updated
External Review of Appealed Claim Denials Flyer  
Technical Release 2011-02  
Federal Register July 2010 07/01/2010
Technical Release 2010-02  
Location (map)
1350 Deming Way, Ste 300
Middleton, WI 53562-4640

Mail Address
PO Box 44347
Madison, WI 53744-4347