skip to Main Content

Notification Relief For Plans on Part C External Reviews

Notification Relief For Plans On Part C External Reviews

A little bit of the burden on external reviews has been lifted from Medicare Advantage (MA) plans by the Centers for Medicare and Medicaid Service (CMS). Effective Jan. 1, 2019, CMS is removing the requirement for plans to notify enrollees upon forwarding Part C denial cases to the Independent Review Entity (IRE).

 The IRE will continue to be contractually responsible for notifying enrollees upon receipt of cases from Medicare Advantage (MA) plans. CMS made this change to ease the burden on MA plans without compromising notice to the enrollee (or other party) of the progress of the appeal.

 This move will allow plans to redirect resources to time-sensitive activities, such as review of coverage requests and improved efficiency in appeals processing and provision of health benefits.

 Remember that all the same requirements related to what needs to be auto-forwarded and by what timeframe remain in place for both Parts C and D.

 We are hearing that some plans will continue to issue the notices anyway to ensure member satisfaction.

Levo Health

This is Levo Health Bio.

Back To Top