MANAGED CARE April 1999. ©1999 Stezzi Communications
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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.