TX HMO Script – Refund Recoupment
May 5, 2021 5:29 pmASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
Archives
TX HMO Script – Poststabilization Timeframe
May 5, 2021 5:17 pmASK YOURSELF: When was the patient stabilized in the emergency room or admitted as an inpatient? Was it during normal... View more
TX HMO Script – Notice Requirements for Adverse Determinations
May 5, 2021 4:52 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
TX HMO Script – No Authorization for ER Services and Care
May 5, 2021 4:49 pmASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
TX HMO Script – Medical Necessity – Qualified Reviewers
May 5, 2021 4:32 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
TX HMO Script – Maternity Coverage
May 5, 2021 4:25 pmASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more
TX HMO Script – Interest Owed on Late Claims
May 5, 2021 4:21 pmASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did they pay this claim... View more
TX HMO Script – Non-urgent Authorization Timeframes
May 5, 2021 4:17 pmASK YOURSELF: What date was the request for non-urgent authorization made? Was there any written communication (request for information, denial,... View more
TX HMO Appeal – Untimely Payment
May 5, 2021 3:54 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Texas Department... View more
TX HMO Appeal – Retroactive Denial for Authorized Care
May 5, 2021 3:53 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Texas Department... View more