NY HMO Affidavit – Maternity Coverage
May 4, 2021 7:42 pmAFFIDAVIT OF COMPLIANCE Maternity Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
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NY HMO Affidavit – Interest Owed on Late Claims
May 4, 2021 7:28 pmAFFIDAVIT OF COMPLIANCE Interest Owed on Late Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
NY HMO Affidavit – Non-urgent Authorization Timeframes
May 4, 2021 7:27 pmAFFIDAVIT OF COMPLIANCE Timeframes for Authorization Requests – Non-Urgent Health Services Incorporated by Reference in 28 US Code § 1746... View more
FL HMO Script – Untimely Payment
May 4, 2021 4:28 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
FL HMO Script – Retroactive Denial for Authorized Care
May 4, 2021 4:24 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation... View more
FL HMO Script – Refund Recoupment
May 4, 2021 4:18 pmASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
FL HMO Script – Poststabilization Timeframe
May 4, 2021 4:13 pmASK YOURSELF: When was the patient stabilized in the emergency room or admitted as an inpatient? Was it during normal... View more
FL HMO Script – Notice Requirements for Adverse Determinations
May 4, 2021 4:08 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
FL HMO Script – No Authorization for ER Services and Care
May 4, 2021 4:05 pmASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
FL HMO Script – Medical Necessity – Qualified Reviewers
May 4, 2021 4:00 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more