August 16, 2013 Legislative Update Affordable Care Act Question of the Week: Appeals and External Review The “Question of the Week” addresses frequently asked questions regarding the Affordable Care Act (ACA). This week, we are answering a question in regards to the appeals and external review process. Q. If the appeal goes to the external review and gets overturned, does that automatically go to Blue Cross and Blue Shield of Illinois to process the adjustment of that claim? A. Yes. If the Independent Review Organization (IRO) overturns the denial, our Service Delivery and Operations Division will process the adjustment within a reasonable timeframe. |