Regulatory Compliance

 

Ensures compliance with State and Federal laws, rules and regulations governing medical management.

American Health is committed to being in compliance with rules and regulations governing our business.  We have done significant research to ensure that we have in-depth knowledge and understanding of applicable state laws in addition to the regulations set forth by the Health Insurance Portability and Accountability Act (HIPAA), the Department of Labor (DOL), and URAC. 

 

Fast Facts

• Utilization Management, Case Management, Disease Management, and Health-e Outlook Web Site are fully accredited by URAC
  Expanded nurse coverage ensures Urgent and Concurrent Reviews are handled 7 days a week in accordance with time frames set forth by the DOL and URAC
• Formal policies and procedures ensure compliance with DOL regulations for ERISA plans and state regulations for non-ERISA plans
• Appeals processes and notification letters comply with DOL regulations and all state licensure requirements (e.g., determination time frames, response deadlines, letter contents, etc.)
• Our proactive approach to HIPAA compliance includes appointing a senior level HIPAA Privacy Officer and a multidisciplinary HIPAA compliance project team to ensure timely and comprehensive compliance
• A dedicated Compliance department continually analyzes all business operations and processes to ensure compliance with HIPAA requirements, DOL regulations and all applicable State laws 
• Technical, physical and administrative security features and policies have been implemented to reduce the possibility of unauthorized use or disclosure of protected health information (PHI) or other sensitive information
• We are Claredi certified as HIPAA compliant for the 278 and 834 transactions