Commission for Case Manager Certification (CCMC) Practice Exam 2025 - Free Case Manager Certification Practice Questions and Study Guide

Question: 1 / 400

External review is typically handled by which entity when an adverse benefit determination occurs?

Internal audit committee

Federal healthcare authority

Outside insurance company

When an adverse benefit determination occurs, external review is typically handled by an outside insurance company. This process is essential because it provides an independent evaluation of the case and aims to ensure that the decision-making process regarding benefits is fair and complies with established regulations. An outside insurance company can bring a fresh perspective, as it is not involved in the initial decision, and can help safeguard consumers' rights by reviewing the rationale behind the denial of benefits.

This external entity often assesses whether the decision aligns with the terms of the insurance policy and applicable laws, which protects both the insured individual's interests and the integrity of the insurance system. Having an unbiased third party conduct the review helps ensure that the process is transparent and that there is accountability in insurance practices.

Get further explanation with Examzify DeepDiveBeta

Patient advocacy group

Next Question

Report this question

Download Commission for Case Manager Certification (CCMC) Practice Exam 2025 - Free Case Manager Certification Practice Questions and Study Guide PDF Study Guide
Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy