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Physicians Need Patient Coverage Status at Start of Grace Period
Posted on: 3/21/2014

Patients who have purchased health insurance coverage with premium subsidies through the Affordable Care Act (ACA) marketplace have a three-month grace period if they miss a monthly premium.

During the first 30 days of the grace period, plans on the exchanges (or issuers) are required to pay for claims submitted. However, during months two and three of the grace period, issuers are allowed to pend payments and even denyclaims.

ISMS joins dozens of other local and national medical organizationsto urge the Centers for Medicare and Medicaid Services to require that issuers notify physicians at the time of eligibility verification when an insured who has purchased subsidized ACA exchange coverage enters the first month of the grace period.

Physician practices must have accurate, up-to-date information so they can plan for potential financial liabilities associated with non-coverage.

Visit ISMS' ACA Grace Periodwebpage for more details and resources.

Questions? Call your ISMS Advocacy Team at 800-782-4767 ext. 1470 or send an email.

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