How does the final Claims Regulation affect the services First Health provides to me?
The Final Claims Regulation will affect First Health’s administration services quite significantly. The claims regulation will impact our claims and appeals areas by reducing the time frames to adjudicate a claim or handle an appeal. You, as your plan’s fiduciary, will need to be involved at all levels of appeal. Also, for the first time, “preservice” claims are addressed in federal regulations. However, the time frames are generally more generous than those required by URAC or state law. The claims regulation will likely require First Health to revise its staffing levels to satisfy these regulatory requirements, and we will need to modify claims policies and procedures to accommodate the changes. Specific requirements will be discussed in detail below.
