PPACA Compliance for Plan Administrators & TPAs: 2013 PPACA & ERISA Claims Specialist Certification Programs

PPACA Compliance for Plan Administrators & TPAs: 2013 PPACA & ERISA Claims Specialist Certification Programs

Avym Corporation announces 2013 PPACA & ERISA Claims Specialist Educational Program for Plan Administrators and TPAs, in order to comply with 2013 full implementation of PPACA claims regulations. 

Avym Corporation (Avym) announces 2013 PPACA & ERISA Claims Specialist Educational Program for Plan Administrators (PA) and Third Party Administrators (TPAs).  This program is the first of its kind in healthcare history and is designed to comply with 2013 full implementation of PPACA claims regulation, at a time when 82.1% of large health plans (>500) are self-insured.

Avym offers these programs as the Employee Benefits Security Administration (the arm of the U.S. Department of Labor that enforces Title I of ERISA) ramps up audits of group health plans.  The EBSA has updated its audit protocols to include a review of plans’ compliance with the Patient Protection and Affordable Care Act (PPACA) in consequence of the fact that in 2013, failure by plan administrators and TPAs to substantially comply with PPACA and ERISA claims regulations may result in substantial administrative penalties, legal liabilities and court costs.  The new federal health care reform law, PPACA, went into effect on March 23, 2010, and PPACA claims regulation went into effect on September 23, 2010.  PPACA adopts ERISA claim regulations of 37 years in its entirety as minimum internal appeal standards.

Avym Corporation’s 2013 PPACA & ERISA Claims Specialist Educational Program for Plan Administrators (PA) and TPAs is timely in light of a recent 5th Circuit court decision on January 4th , 2013, affirming a district court ERISA decision against a TPA in awarding $453,000 in attorney fees and $512,000 in medical bills for making claims denial and appeal decisions.

(The court case information: LifeCare Management Services LLC v. Insurance Management Administrators Incorporated, No. 11-10733, Filed on January 4, 2013, United States Court of Appeals, Fifth Circuit)

“The DOL Fiduciary Guidance for all TPAs in “Maintaining the Plan’s Benefits Claims Procedure” states “While many plans hire benefits professionals or insurance companies to process claims, it is important for an employer to understand the requirements before selecting a service provider who can comply with the standards.” commented Vincent Flores, President and co-founder of AVYM Corporation and certified PPACA and ERISA claims specialist. (http://www.dol.gov/ebsa/publications/ghpfiduciaryresponsibilities.html)

Avym’s programs are immediately available to the public in both basic and advanced private certification programs.  No such known public programs of its kind have ever been made available in 37 years of existing ERISA regulation.  These programs are educational in nature to assist all plan administrators and TPAs maintain compliance with PPACA and ERISA mandates in order to:

  • Contain healthcare costs
  • Protect plan participants and beneficiaries in fulfilling plan fiduciary duties
  • Improve health care quality and patient- provider relationships

The basic programs will be two days, the advanced private certification programs will be eight days. The pricing for these programs will depend upon the number of attendees in each group session.

“If every healthcare provider is required to obtain a medical license and/or credentialing to perform services in order to be paid then it stands to reason that every TPA or plan fiduciary should have at least some minimum ERISA or PPACA education, license or certification in order to manage claim denials and appeals from healthcare providers and patients,” noted Mark Flores, Vice President and co founder of AVYM Corporation, and certified PPACA and ERISA claims specialist.

The greatest way to contain healthcare costs and at the same time shield fiduciary liabilities is proactive compliance with all governing laws when making claim denials and appeal decisions under ERISA and PPACA.

“Nearly 82.1% of large health plans (>500 employees) are self-insured at least one plan, according to the HHS and DOL PPACA “Report to the Congress on a Study of the Large Group Market”, and in 2013, PPACA claims regulations are in full implementation and enforcement, after the Extension of Non-Enforcement Period expired,” said Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA and PPACA compliance, who educated healthcare providers in ERISA and PPACA appeals for more than 12 years.( http://www.dol.gov/ebsa/newsroom/tr11-01.html)

Employer Self-Insurance Decisions and the Implications of the Affordable Care Act (ACA) 

Large Group Health Plans Study 

Avym certification programs are only for personal attendance in private studying of the subject materials specified in each individual program for advancing educational knowledge with respect to applicable PPACA and ERISA compliance.

To find out more about PPACA Claims and Appeals Compliance Services from AVYM please click here.

Located in Los Angeles, CA, AVYM is a leading provider of services focusing entirely on the resolution of denied or disputed medical insurance claims by participating in the nation’s first ERISA PPACA Claims Appeals Certification program.  AVYM also offers free Webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support



Leave a Reply

Your email address will not be published. Required fields are marked *