MA Script – Misdirected Claims
May 24, 2020 6:04 pmASK YOURSELF: Which entity was billed initially (the plan or capitated provider?) What date was the claim was initially billed?... View more
Archives
MA Script – No Claim on File
May 24, 2020 5:34 pmASK YOURSELF: Was the claim billed electronically or physically? What date was the claim initially billed? Do we have a... View more
MA Script – Contract Underpayment
May 24, 2020 5:18 pmASK YOURSELF: Are we contracted with the plan? IF SO, WHAT IS THE EXPECTED REIMBURSEMENT? What date was the claim... View more
MA Script – No Contract Underpayment
May 24, 2020 5:13 pmASK YOURSELF: Make sure we are contracted with the plan. What date was the claim initially billed? When did the... View more
MA Script – Untimely Filing
May 24, 2020 5:10 pmASK YOURSELF: Is this claim or appeal “truly” filed late or has the plan mishandled the initial timely submission of... View more
MA Script – Untimely Payment
May 24, 2020 5:08 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
MA Script – Retroactive Denial for Authorized Care
May 24, 2020 5:01 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation... View more
MA Script – Refund Recoupment
May 24, 2020 4:58 pmASK YOURSELF: How many days after payment, did the MA plan request the refund? Why did the plan request the... View more
MA Script – Notice Requirements for Adverse Determinations
May 24, 2020 3:57 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
MA Script – No Authorization for ER Services and Care
May 24, 2020 3:52 pmASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more