Annapolis, MD and San Marcos, TX / PRWeb / September 11, 2015 – RegQuest™, a new resource that provides health plans, regulators and others with invaluable information regarding current medical management regulations and laws, will announce the debut of the External Review module at the inaugural NAIRO Educational Symposium on September 17, 2015 in San Marcos, Texas
RegQuest™, Your Regulatory Compliance Guide, details many of the business, legal and regulatory forces directly impacting the medical management system, including new requirements adopted under the Affordable Care Act. In addition, this guide serves as the definitive resource for detailing how regulatory and business trends are affecting medical management practices. RegQuest was created in conjunction with Schooner Strategies and EBG Advisors with private funding.
“We are extremely excited to introduce this informative resource into the marketplace,” said Garry Carneal, JD, MA, President and CEO of Schooner Strategies. “Our hope is to provide users with easy to understand summaries of key medical management regulations.” In fact, this is the first time that the state and federal requirements for UM have been updated in a comprehensive reference guide since they were published as the Utilization Management Guide, Third Edition in 2005 during Carneal’s tenure as President and CEO of URAC.
The National Association of Independent Review Organizations (NAIRO), is a collaborative group of companies that provide independent medical reviews, which help payers and medical managers to improve the quality of care, medical utilization and patient safety.
“Compliance with state and federal external review laws is a nuanced endeavor,” notes Julie O’Brien, BSN, RN, MS, president of AliCare Medical Management. “Even though they are complex, these regulations play an important part in consumer protection by ensuring appropriate care is provided for patients and oversight of health plans is designated. RegQuest is a one-stop resource for regulations pertaining to medical management.” O’Brien is also the current president of NAIRO.
Each module of RegQuest provides a detailed description of current state and federal regulations; subscribers will receive notifications from the RegQuest team as updates occur. Trend reports, quick reference tables and educational webinars will also be available.
In addition to the External Review (ER) module, the Utilization Management (UM) module is now available. For both modules, each state has its own section, featuring information on the scope, regulatory contact information, licensure requirements, program requirements, reviewer qualifications, appeals process and other relevant information.
Throughout the remainder of 2015, additional regulatory modules will be uploaded onto the site, including:
- Administrative Appeals and Grievance Procedures
- Case Management
- Other Specialty Programs
“RegQuest is a must-have resource for all stakeholders who require a better understanding of how to comply with state and federal laws impacting health plans and issues regarding medical management and coverage determination,” notes Bob Atlas, MBA, President of EBG Advisors. “In addition, this Compliance Guide is essential for providers, consumer advocates and others who need to file an appeal and better understand what their rights and responsibilities are during the process.”
Attending the NAIRO Symposium? Be sure to stop by and say hello to the RegQuest team! Attendees are eligible for special pricing.
For subscription information and samples of the regulatory documentation available, please click here. Discounts are available for organizations that purchase more than one license and for users who subscribe to more than one module. Contact us for pricing of multiple licenses, consumer advocacy groups and regulators.
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RegQuest™ is an online regulatory compliance guide that provides health plans, regulators and others with invaluable information regarding current regulations and laws. This resource was created in conjunction with Schooner Strategies and EBG Advisors with private funding. Each state in the module will have its own section, featuring information on the scope, regulatory contact information, licensure requirements, program requirements, reviewer qualifications, appeals process and other relevant information.