Treasury, the Department of Labor, and the Department of Health and Human Services jointly issued a technical release giving group health plans until July 1, 2011, to comply with the new internal claims and appeals procedures required under the Patient Protection and Affordable Care Act (PPACA). Under PPACA, non-grandfathered health plans must make several significant changes to their internal disputed-claims procedures. These changes include:

  • Requiring an initial response to an urgent claim within 24 hours
  • Providing notices in a culturally and linguistically appropriate manner
  • Providing broader content and specificity in denial notices
  • Replacing the “substantial compliance” standard for claims review with a “strict liability” standard  

Although PPACA requires that these changes be made as of the first day of the plan year beginning on or after September 23, 2010, the agencies stated they will not take any enforcement action during the grace period against any plan that is working in good faith to implement the additional standards. (Technical Release 2010-02)