NCQA puts external appeals on accreditation to-do list

MANAGED CARE April 1999. ©1999 Stezzi Communications

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.