PA HMO Script – Notice Requirements for Adverse Determinations
October 12, 2021 11:31 amASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
ASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
ASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
ASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did the plan pay this... View more
ASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
ASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more
ASK YOURSELF: What date was the request for non-urgent authorization made? Was there any written communication (request for information, denial,... View more
ASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did the plan pay this... View more
ASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
ASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
ASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more