ClearHealth Quality Institute Seeks Volunteers for New Appeals Standards Committee

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Accrediting Body Seeks to Remedy Long-Standing Problems in Health Insurance Appeals System

ClearHealth Quality InstituteTM (CHQI), which is developing an Appeals Accreditation Program to reform the health insurance appeals system, seeks volunteers to join its newly formed Appeals Standards Committee. The expert panel will be comprised of a diverse group of stakeholders, including health insurance industry leaders, employers, health care providers, and consumer advocates, and will be charged with developing robust but workable standards for health plan internal and external appeals.

“CHQI will develop an accreditation program that will help streamline the health insurance appeals system through the development of national standards,” says Garry Carneal, CHQI’s founder. “A primary public policy goal is to transform the current fragmented appeals system into one that is standardized, transparent, and affords more due process for patients when insurance coverage is denied.” Carneal has brought to market over 20 health care accreditation programs with four different accreditation organizations.

“CHQI, recognizing the huge gaps in this area, will work to bring an industry-wide solution to all parties,” adds Michael D. Reisman, CHQI’s President. “Internal and external appeals regulations are incomplete and ambiguous, and have failed to keep up with the realities of contemporary health care. Our goal is to draft standards to serve as a clear roadmap for the entire appeals process.” Reisman is a former mental health counselor and civil health care prosecutor in the New York State Attorney General’s Office.

The Appeals Standards Committee, which is expected to convene its first meeting by September, will develop new standards during the remaining months of 2017. The standards will undergo multiple levels of rigorous vetting, including a public comment period, beta testing with health plans, and evaluation by CHQI’s Advisory Board of Directors.

The new Appeals Standards Committee will be chaired by Julie O’Brien, BSN, RN, MBA, President and CEO, Alicare Medical Management, and Immediate Past President of the National Association of Independent Review Organizations. Meiram Bendat, J.D., Ph.D., President, Psych-Appeal, Inc., will serve as the Vice-Chair.

“CHQI’s program is urgently needed, as evidenced by the fact that the overwhelming majority of Americans do not know where to file a health plan appeal – even though one in four health insurance claims is denied,” notes Bendat. “A reformed health plan appeals system would ensure that consumers know their rights, while promoting efficiency in health plan administration.”

O’Brien adds, “By bringing together a diverse group of stakeholders including industry, consumer, provider and other representatives, CHQI’s Appeal Standards Committee can identify key target areas to improve how health plans handle insurance appeals.” She notes further, “the time is right to update the appeals process in a way that everyone benefits.”

Several recent trend reports and issue briefs highlight numerous concerns with the current insurance appeals system. Two of these reports, published by CHQI’s regulatory research division, RegQuest, highlighted public policy opportunities to improve both the utilization management internal appeal and external appeal systems. To download previous issue briefs, click here.

The Appeals Accreditation Program is the third initiative launched this year by CHQI, whose mission is to create best-in-class accreditation programs for health plans, providers, medical management organizations and other health-related companies. Earlier this year, CHQI announced the launch of cutting-edge telemedicine and mental health parity accreditation programs. Leveraging its leaders’ decades of experience in health care, compliance, and accreditation, CHQI aims to promote value and accountability in the health care system.

To obtain more information about the CHQI Appeals Standards Committee, including serving as a volunteer member, or other CHQI accreditation programs, please contact Julie Irons, Manager of Accreditation, at (410) 696-7634 or via email at info(at)chqi.com.

About ClearHealth Quality Institute™ (CHQI) (http://www.CHQI.com)
The mission of ClearHealth Quality Institute (CHQI) is to promote quality-based practices for health plans, providers and other stakeholders across the United States and its territories. CHQI’s accreditation and certification programs help assess, track and report on trends to enhance key insurance and provider outcomes. CHQI also offers regulatory compliance solutions, hosts educational programs, publishes issue briefs, and underwrites research to raise awareness of patient safety issues and promote best practices. The organization is governed by an independent board and committee system, which is open to a wide range of volunteers to ensure transparency and accountability. CHQI provides resources to serve patients, providers, payers, government agencies, and other stakeholder groups. To learn more about CHQI, please contact us at (410) 696-7634 or info(at)CHQI.com.

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Tony Ellis
@ClearHealthQI
since: 03/2017
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