MA Fax Cover Sheet – Notification of Disagreement of Care
December 30, 2024 12:03 amNOTIFICATION OF DISAGREEMENT OF CARE On , you notified our facility that further post-stabilization... View more
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CA HMO Fax Cover Sheet – General Ambulance Transport Request for Authorization
December 29, 2024 6:15 pmREQUEST FOR AUTHORIZATION At this time, we are requesting authorization to provide transportation services... View more
CA HMO Fax Cover Sheet – General Ambulance Transport Appeal
December 29, 2024 3:02 pmREQUEST FOR RECONSIDERATION We believe you have failed to comply for the following reasons:... View more