NCQA puts external appeals on accreditation to-do list

The National Committee for Quality Assurance has given health plans a compelling reason to set up external-appeals processes for members who have exhausted internal avenues for redress. Beginning next year, HMOs seeking accreditation must have a third-party reviewer — an independent, NCQA-approved organization — in place.

In the wake of expensive jury verdicts and under a threat of federal legislation, many health plans — worried that their liability shield, the Employee Retirement Income Security Act of 1974, is rusting away — have voluntarily established third-party review. In late February, the American Association of Health Plans urged its member health plans to adopt external-appeals processes.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

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