LB77-The Ensuring Transparency in Prior Authorization Act Sec. (7) (4)
September 10, 2025 10:32 pm(4) Health care services are deemed authorized if a utilization review agent fails to comply with the deadlines for making... View more
Archives
LB77-The Ensuring Transparency in Prior Authorization Act Sec. (7) (1)
September 10, 2025 10:31 pm(1) Prior to January 1, 2028, if a utilization review agent requires prior authorization of a health care service, the... View more
NE HMO Script – Untimely Payment
September 10, 2025 10:16 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
NE HMO Script – Retroactive Denial for Authorized Care
September 10, 2025 10:05 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? If so, what date and time? Did the plan make... View more
NE HMO Script – Refund Recoupment
September 10, 2025 9:54 pmASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
NE HMO Script – Poststabilization Timeframe
September 10, 2025 9:40 pmASK YOURSELF: When was the patient stabilized in the emergency room or admitted as an inpatient? Was the admission during... View more
NE HMO Script – Notice Requirements for Adverse Determinations
September 10, 2025 9:37 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
NE HMO Script – No Authorization for ER Services and Care
September 10, 2025 9:15 pmASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
NE HMO Script – Medical Necessity – Qualified Reviewers
September 10, 2025 9:02 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
NE HMO Script – Maternity Coverage
September 10, 2025 8:52 pmASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more