CO HMO Script – Untimely Payment
May 4, 2021 3:47 amASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
Archives
CO HMO Script – Retroactive Denial for Authorized Care
May 4, 2021 3:43 amASK YOURSELF: Was the coverage terminated? Did we verify eligibility? If so, what date and time? Did the plan make... View more
CO HMO Script – Refund Recoupment
May 4, 2021 3:41 amASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
CO HMO Script – Poststabilization Timeframe
May 4, 2021 3:35 amASK YOURSELF: When was the patient stabilized in the emergency room or admitted as an inpatient? Was the admission during... View more
CO HMO Script – Notice Requirements for Adverse Determinations
May 4, 2021 3:31 amASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
CO HMO Script – No Authorization for ER Services and Care
May 4, 2021 3:28 amASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
CO HMO Script – Medical Necessity – Qualified Reviewers
May 4, 2021 3:25 amASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
CO HMO Script – Maternity Coverage
May 4, 2021 3:22 amASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more
CO HMO Script – Interest Owed on Late Claims
May 4, 2021 3:18 amASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did the plan pay this... View more
CO HMO Script – Non-urgent Authorization Timeframes
May 4, 2021 2:59 amASK YOURSELF: What date was the request for non-urgent authorization made? Was there any written communication (request for information, denial,... View more