Health Plans Face New Liabilities for Inaccurate Provider Directories

Learn about the Consolidated Appropriations Act provisions that protect health plan enrollees from unexpected out-of-network bills caused by inaccurate provider directories in this article from the thought leaders at Mercer.

READ NOW »

Related Content

• Complaint and Grievance Procedures in Health Insurance
  Get clarity on the process for handling complaints and grievances filed by individuals who are covered under commercial health insurance policies, including structure of the complaint and grievance review process, state and federal statutory and regulatory requirements, and tips for conducting legal research on the topic.  

• Claims Appeal External Review Procedures in Health Insurance
  Explore external reviews of adverse determinations involving claims for payment for healthcare services under a commercial health insurance policy.

• Healthcare Discount Plans
  Walk through the operational and regulatory compliance matters for healthcare discount plans, including licensing and registration, reporting requirements, the impact of the National Association of Insurance Commissioners’ (NAIC) Discount Medical Plan Organization Model Act, and key issues to consider when advising a client engaged in the marketing, sale, and administration of discount plans.

• Healthcare Discount Plans Checklist
  Examine discount plans offering discounts on physician-provided medical services, including research tips to assist attorneys with advising clients about matters related to discount plan operations and compliance matters.

• Claims Processing in Health Insurance
  Analyze the facets of claims processing for commercial health insurance plans, in both individual and group contexts, including the fundamental elements of claims processing for medical and hospital claims, how to define a claim, a claims timeline, claims forms, and researching applicable laws, such as ACA, ERISA, and NAIC model laws and regulations that govern claims processing.  

Practical Guidance Updates
Featuring the latest updates from your Practical Guidance account.   

• Insurance Regulatory Compliance Resource Kit
• Healthcare Transactions, Licensing, and Regulation Resource Kit

Experience results today with practical guidance, legal research, and data-driven insights—all in one place.

Experience Lexis+