The Health Advocate External Appeals Administration program assists plan sponsors with all facets of the federally mandated external appeals process, offering an unbiased, third party solution for the external appeals process. Our complete, fully independent, turnkey solution can help employers with self-funded plans comply with regulations and timelines for external appeals when members’ claims have been denied. Our seasoned team of medical and benefits experts secure cost-effective, discounted contracts with outside, qualified Independent Review Organizations (IROs), passing along the savings from these outside contracts. Cases are randomly assigned to three IROs, as required by the regulations. Our team closely monitors the review process at each step to ensure timely responses and compliance, including expedited reviews when necessary. We collect, document and track information, and provide all required notices and reports. We alert the plan administrator and carrier of the decision and follow up to ensure that the member’s appeal, if successful, is adjusted promptly and properly.
Key Benefits:
- Saves money
- Meets requirements of law for external appeals process
- Unbiased appeals review ensures fair treatment of legal rights
- Highly experienced team of medical and benefits experts
- Meets Department of Labor requirements of the independent management of the process
- Ensures compliance with strict ERISA regulations and timelines
- Contracts and secures discounts with several outside IROs, passing along savings
- Randomly assigns cases to three IROs, as required by law
- Collaborates with clients to develop required collateral materials
- Capability to facilitate expedited reviews
- Provides proper reporting; avoids costly penalties
- Expedites installation to meet deadlines
- Eases burden on HR staff
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