MAXIMUS operates health care appeal programs for state regulatory agencies

The United States Departments of Health and Human Services, Labor and the Treasury announced yesterday a new internal claims and appeals and external review process for group health plans under the Patient Protection and Affordable Care Act.

“As an independent organization without any conflicts of interest, MAXIMUS stands ready to assist government agencies, employers, consumers and insurance carriers in meeting the requirements of this important government initiative”

The new appeal rules transform the current highly variable health claims and appeals process into one that is more uniform and structured. External appeals will be a new requirement for many group health plans and insurance carriers, as consumers in new health plans in every state will now have the right to appeal decisions to an independent outside entity.

As the recognized industry leader for government-sponsored health care appeal programs at the state and federal level, MAXIMUS brings over twenty years of experience in providing independent reviews. Through its MAXIMUS Federal subsidiary, MAXIMUS operates health care appeal programs for over 35 state regulatory agencies, as well as the Centers for Medicare and Medicaid Services, the United States Office of Personnel Management and the Department of Defense TRICARE program.

"As an independent organization without any conflicts of interest, MAXIMUS stands ready to assist government agencies, employers, consumers and insurance carriers in meeting the requirements of this important government initiative," commented MAXIMUS CEO Richard Montoni.

SOURCE MAXIMUS