Julie O’Brien, AliCare Medical Management President Named Chair, New Appeals Standards Committee by ClearHealth Quality Institute

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Accrediting body seeks fix to long-standing problems in health insurance appeals system

Julie O’Brien, BSN, RN, MBA, President of Alicare Medical Management (AMM) has been appointed by ClearHealth Quality InstituteTM (CHQI), to lead an expert panel comprised of a diverse group of stakeholders including health insurance industry leaders, employers, health care providers, and consumer advocates charged with developing robust but workable standards for health plan internal and external appeals.

“Ms. O’Brien is uniquely qualified for this new role through her leadership of AMM, recognized as the country’s premier medical management company for over three decades, and having served as the Immediate Past President of the National Association of Independent Review Organizations,” said Garry Carneal, CHQI’s founder.

“I’m excited to be part of developing an accreditation program that will bring much needed improvement to the health insurance appeals system through development of national standards. By bringing together a variety of stakeholders including industry, consumer, provider and other representatives, we’ll identify key areas to improve how health plans handle insurance appeals in a way that everyone benefits,” states O’Brien. “My organization helps clients navigate and manage very complex external and internal review systems; there is no doubt an improved roadmap will help consumers and improve health plan efficiency.”

According to Carneal, “A primary policy goal is to transform the current fragmented appeals system into one that is standardized, transparent, and provides more due process for patients when insurance coverage is denied. A majority of consumers don’t even know they have the right to appeal; a reformed system will ensure they know their rights.” Carneal has brought to market over 20 health care accreditation programs with four different accreditation organizations.

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

To learn more about the extensive care management services offered by AMM and how our expertise can help your organization promote clinical and financial outcomes for the populations you serve either directly or through private label services, contact us at (800) 863-8688 or email at info@alicaremed.com.

Our seamless 24/7/365 care management solutions include:

  • Utilization Management Services
  • Case Management
  • 24-7 Nurse HelpLine Services
  • Expert Physician Review
  • Appeals Solutions
  • Readmission Management and Patient Transition Coaching
  • Maternity Management
  • Medical Claims Review
  • Disability Management
  • 24-Hour Network Referral

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@chqi.com.

About AliCare Medical Management
AliCare Medical Management (AMM), a member of the Amalgamated Family of Companies, is a national leader in developing care management solutions that promote cost savings and patient satisfaction. AMM’s call center is open 24 hours a day, 365 days a year to provide maximum access and assure optimum program effectiveness. The company’s services include: 24-hour Nurse HelpLine, Utilization Management, Maternity Management, Case Management, Disease Management, Health Coaching and Wellness, Independent Physician Review, Medical Claims Review and Hospital Bill Auditing. AMM holds four URAC accreditations for Utilization Management, Case Management, Health Call Center and Independent Review. For more information, visit: http://www.alicaremed.com

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Janice Blattenberger
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