At The Podium
Are the EOBs from your TPPs deficient? Improving your health plan’s claims procedures
While speaking at the SouthWest Benefit Association’s 2017 Benefits Administration Workshop in Oklahoma City, McAfee & Taft employee benefits attorney Brandon Long is joined by representatives from the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) and HUB International to discuss best practices for improving a health plan’s claim procedures. The presentation also includes a review of common mistakes and how to avoid them.
- Who is responsible for making claims decisions?
- The consequences of not following plan procedures
- Fiduciary responsibilities under a group health plan
- Types of claims for benefits, including pre-service and post-service claims and concurrent care decisions
- Where and how to document claim and appeal procedures
- Steps to provide a notice of adverse benefit determinations
- Procedures for appeals of adverse benefit determinations
- The role of independent review organizations (IROs)Timelines for standard and expedited external review
SouthWest Benefits Association is a regional association of experienced professionals in the field of employee pension and welfare benefits. Members represent a wide range of specialties, including corporate human resources, benefit plan administration, financial management, investment counseling, trust administration, law, accounting, actuarial, health insurance, and pension and welfare consulting. Through an annual schedule of professional educational conferences and seminars, SWBA provides discussion of a wide range of issues confronting benefit professionals.