• Federal External Review Procedure for Group Health Plans
  • September 1, 2010 | Authors: Mary C. DeYoung; Amy N. Moore; John M. Vine
  • Law Firm: Covington & Burling LLP - Washington Office
  • The health reform law requires non-grandfathered group health plans to meet new standards for processing internal claims and appeals, and also requires these plans to implement a new external review procedure. On August 23 the federal agencies charged with interpreting these requirements released several pieces of guidance on the external review procedure and provided model notices for both internal and external claims decisions. Links to these documents appear at the end of this memorandum.