PPACA Compliance Deadline Extended on Claims Procedures

The Departments of Labor, Health and Human Services and Treasury keep extending the compliance deadline of a provision of the Patient Protection and Affordable Care Act (PPACA) affecting non-grandfathered health insurance plans.

PPACA originally set the deadline for Jan. 1, 2011, but before that date even rolled around, it was extended to July 1, 2011. On March 18 the deadline was extended once again, this time to Jan. 1, 2012 (or the first day of the plan year that falls after that).

Under PPACA, health insurers will face a 24-hour window to notify plan participants of urgent care claim decisions. If the decision is not made and the claimant not notified in that period, the claim is deemed to be denied, opening up the insurer to lawsuit or external review.

In addition, these notices must be culturally and linguistically appropriate, meaning they might have to be in a language other than English. Finally, the notices must disclose both the diagnostic and treatment codes, along with explanations of what they mean.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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