MO HMO Script – Interest Owed on Late Claims
October 15, 2021 7:27 amASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did the plan pay this... View more
Archives
MO HMO Script – Maternity Coverage
October 15, 2021 7:26 amASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more
MO HMO Script – Medical Necessity – Qualified Reviewers
October 15, 2021 7:25 amASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
MO HMO Script – No Authorization for ER Services and Care
October 15, 2021 7:25 amASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
MO HMO Script – Notice Requirements for Adverse Determinations
October 15, 2021 7:24 amASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
MO HMO Script – Retroactive Denial for Authorized Care
October 15, 2021 7:23 amASK YOURSELF: Was the coverage terminated? Did we verify eligibility? If so, what date and time? Did the plan make... View more
MO HMO Script – Untimely Payment
October 15, 2021 7:20 amASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
MO HMO Script – Poststabilization Timeframe
October 15, 2021 7:16 amASK YOURSELF: When was the patient stabilized in the emergency room or admitted as an inpatient? Was the admission during... View more
MCL §500.2006(3)
October 15, 2021 7:05 am(a) A clean claim must be paid within 45 days after receipt of the claim by the health plan. A... View more
MCL §500.2213(j)
October 15, 2021 7:05 am(j) That when an adverse determination is made, a written statement containing the reasons for the adverse determination is provided... View more