Are You Ready For 2011 New Federal Prompt Pay Laws Under Health Reform PPACA? – For PPACA & ERISA Claim Specialists

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On Jan 01, 2011, New Federal Internal And External Prompt Pay Laws Under Health Reform Laws, PPACA, Will Be Effective For All Non-Grandfathered Health Plans And Individual Policies. Announced New Federal Prompt Pay Law Trainings For PPACA & ERISA Claim Specialist And Free Webinars For 2011. Logo

On December 21, 2010, announced 2011 new Federal Prompt Pay Law training for PPACA & ERISA Claim Specialists Class and Free Webinars for 2011. New federal claims and appeals regulation went into effect on September 23, 2010, with an enforcement grace period until July 2, 2011, for all non-grandfathered group health plans and individual policies in claims timely reimbursement and appeals. Most group health plans have plan new calendar year starting on Jan. 01, 2011, thus must comply with new federal internal and external prompt pay laws, the internal and external claims and appeals regulations. Failure by a plan to strictly comply with new federal internal and external appeal regulations may result in $100 per day per patient excise tax penalty under PHS Act §2719(b) of PPACA, Patient Protection and Affordable Care Act.

“For the first time in U.S. healthcare history, the new Patient’s Bills of Rights Regulations and Guidance clarify and mandate Federal Prompt Pay laws to mean “immediately authorizing or immediately paying benefits” upon receipt of a notice of a final external review decision reversing the adverse benefit determination or final internal adverse benefit determination, or non-adverse benefits determination,” said Dr. Jin Zhou, President of, a national expert on ERISA and PPACA appeals and compliance.

Technical Guideline from HHS, IRS & DOL pays to cash in on PPACA compliance:

“4. Reversal of plan’s decision. Upon receipt of a notice of a final external review decision reversing the adverse benefit determination or final internal adverse benefit determination, the plan immediately must provide coverage or payment (including immediately authorizing or immediately paying benefits) for the claim.” [Page 6 of 8]

“For the first time, Federal Prompt Pay Laws, 29 CFR 2560.503-1(f), are enforceable with internal claim timely notification of benefit determination’, enforced with new external appeal timely of notification of benefit determination with ‘immediately authorizing or immediately paying benefits’: 48 hours for urgent care claims, 15 days for pre-service claims, 30 days for post-service claims, 45 days for non-clean claims, and 45 days for external appeals,” simplified by Dr. Zhou.

For more information:

Dr. Zhou will further demystify new Federal Prompt Pay Laws in 2011 free webinars and advanced PPACA & ERISA Claims Specialists Certification and Appeals Department Programs. PHS Act §2719(a) of PPACA adopted existing 36 year old ERISA claim regulations, 29 CFR §2560.503-1, in its entirety, as the minimum requirements for PPACA internal claims and appeals, and PHS Act §2719(b) adopted NAIC Uniform External Review Model Act for new Federal External claims and appeals. All grandfathered ERISA health plans must substantially comply with existing ERISA regulation of 36 years with respect to timely benefits determination, “immediately paying benefits” upon benefits determinations with approved payments under 29 CFR §2560.503-1(f).

“We finally see the real teeth of ERISA from PPACA after we have felt hopeless and frustrated during the past 10 years when some health plans would ignore our ERISA appeals. New Patient's Bill Of Rights Regulations will protect those who comply faithfully and punish those who fail to strictly comply,” said Vince Flores, Vice President of Yolanda Flores Corp., which recently enrolled in’s PPACA & ERISA Claim Specialist Certification Program in 2011.’s PPACA & ERISA Claim Specialists Certification Programs are established to provide expert guidance in understanding, implementation and compliance with PPACA:

HHS, DOL & IRS: “Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights”

HHS, DOL & IRS News Release: “Administration Announces New Affordable Care Act Measures to Protect Consumers and Put Patients Back in Charge of Their Care”

HHS, DOL & IRS: “Fact Sheet: The Affordable Care Act: Protecting Consumers and Putting Patients Back in Charge of Their Care July 22, 2010

The Affordable Care Act will help support and protect consumers and end some of the worst insurance company abuses. For too long, consumers have been forced to fend for themselves in a health care system that did not provide them with the support and assistance they needed and deserved. Today, the Obama Administration is announcing new regulations that will allow consumers to appeal decisions made by their health plans and the availability of resources that will be used to help give consumers more control of their health care decisions.”

Complete Affordable Care Act Regulations and Guidance can be found on DOL website:

Located in a Chicago suburb in Illinois, is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For more information on how to become an ERISA-PPACA & ERISA Claims Specialist under new and existing federal appeals regulations:

For free Webinars:

For any questions, please contact Dr. Jin Zhou, president of, at 630-808-7237.

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