RI HMO Script – Refund Recoupment
October 12, 2021 11:07 amASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
Archives
NJ HMO Script – Non-urgent Authorization Timeframes
October 12, 2021 11:05 amASK YOURSELF: What date was the request for non-urgent authorization made? Was there any written communication (request for information, denial,... View more
RI HMO Script – Untimely Payment
October 12, 2021 11:03 amASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
NJ HMO Script – Notice Requirements for Adverse Determinations
October 12, 2021 11:01 amASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
NJ HMO Script – Refund Recoupment
October 12, 2021 10:59 amASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
NJ HMO Script – Maternity Coverage
October 12, 2021 10:55 amASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more
NJ HMO Script – Untimely Payment
October 12, 2021 10:31 amASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
NJ HMO Script – Interest Owed on Late Claims
October 12, 2021 10:22 amASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did the plan pay this... View more
RI HMO Script – Medical Necessity – Qualified Reviewers
October 12, 2021 10:21 amASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
KS HMO Affidavit – Untimely Payment
October 11, 2021 8:48 pmAFFIDAVIT OF COMPLIANCE Prompt Payment to Providers Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more