MA Appeal – Notice Requirements for Adverse Determinations
April 6, 2022 3:40 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Centers for... View more
Archives
VHA Handbook 1330.03(2.)(d.)
September 5, 2020 4:59 pm2. Authority d. Pursuant to 38 U.S.C. § 1786, VA may provide newborn health care services, for up to but... View more
42 CFR §422.101(b)
September 5, 2020 4:54 pm(b) Comply with – (1) CMS’s national coverage determinations; (2) General coverage guidelines included in original Medicare manuals and instructions... View more
Welfare & Institutions Code §14133.9(d)
September 3, 2020 5:13 am(d) When a proposed treatment meets objective medical criteria, and is not contraindicated, authorization for the treatment shall be provided within... View more
CA MEDI-CAL Affidavit – ETAR Authorization Timeframes
September 3, 2020 5:06 amAFFIDAVIT OF COMPLIANCE Timeframes for ETAR Authorization Requests Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
CA Medi-Cal Appeal – ETAR Authorization Timeframe
September 3, 2020 5:03 amIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of... View more
VA Website Blurb – Contact the VA After Receiving ER Care
September 3, 2020 4:28 am“Once a Veteran’s immediate emergency medical care needs have been addressed, the Veteran, a family member, friend, or hospital staff... View more
42 CFR §422.566(d)
September 3, 2020 3:47 amIf the MA organization expects to issue a partially or fully adverse medical necessity (or any substantively equivalent term used... View more
California Department of Health Care Services
August 28, 2020 4:44 pmWithin the California Department of Health Care Services, the Medi-Cal Managed Care and Mental Health Office of the Ombudsman helps... View more
VHA Script – Retroactive Denial for Authorized Care
May 24, 2020 7:06 pmASK YOURSELF: What date was the claim initially billed? Is there an Authorization on file? Were the services rendered consistent... View more