Archives
CA HMO Affidavit – Good Cause for Untimely Billed Claims
September 5, 2020 3:32 amAFFIDAVIT OF COMPLIANCE Good Cause for Untimely Billed Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:... View more
CA HMO Affidavit – Denial of Timely Billed Claims
September 5, 2020 3:32 amAFFIDAVIT OF COMPLIANCE Denial of Timely Billed Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
CA HMO Script – Unlawful Offset
September 3, 2020 5:29 amASK YOURSELF: How many days after payment, did the Knox-Keene plan request the refund? Why did the plan request the... View more
CA HMO Script – Untimely Filing Medical Necessity Exception
September 3, 2020 5:23 amASK YOURSELF: Is this claim or appeal “truly” filed late or has the plan mishandled the initial timely submission of... View more
Administrative Code §22.484(g)(B)
September 3, 2020 4:41 am(ii) Establish and prescribe, by resolution, regulations providing for the operation of, the extent, character and quality of service, the... View more
CA HMO Script – Poststabilization Timeframe
August 31, 2020 4:56 pmASK YOURSELF: When was the patient stabilized in the emergency room or admitted as an inpatient? Was it during normal... View more
CA HMO Script – Concurrent Disagreement of Care
August 30, 2020 9:05 pmASK YOURSELF: Has the patient been stabilized in the emergency room or admitted as an inpatient? Did the hospital make... View more
CA HMO Script – Uncontested Portion of Claim Denial
August 30, 2020 9:05 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
CA HMO Script – COB Denial
August 30, 2020 8:55 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial) from the... View more