CA HMO Script – Request for Insignificant Information
August 30, 2020 8:43 pmASK YOURSELF: Was the claim billed electronically or physically? What date was the claim initially billed? Were the services authorized?... View more
Archives
CA HMO Script – Unauthorized Treatment
August 30, 2020 8:34 pmASK YOURSELF: Who denied the claim (name, title)? What is the professional’s license number with the State Medical Board? Were... View more
CA HMO Script – Silent PPO
August 30, 2020 8:20 pmASK YOURSELF: Make sure we are not contracted with the plan. What date was the claim initially billed? When did... View more
CA HMO Script – Patient not Eligible
August 30, 2020 8:18 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation... View more
CA HMO Script – Retroactive Denial Trend
August 30, 2020 8:00 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? IF SO, WHAT DATE? Did the plan negligently misrepresent the... View more
CA HMO Script – LA City Ambulance Transport No Contract Underpayment
August 30, 2020 7:13 pmASK YOURSELF: Did this transport originate in the City of Los Angeles? Are we contracted with the plan? What date... View more
CA HMO Script – Misdirected Claims
August 30, 2020 7:09 pmASK YOURSELF: Which entity was billed initially (the plan or capitated provider?) What date was the claim was initially billed?... View more
CA HMO Script – No Claim on File
August 30, 2020 7:06 pmASK YOURSELF: Was the claim billed electronically or physically? What date was the claim initially billed? Do we have a... View more
CA HMO Script – Contract Underpayment
August 30, 2020 7:02 pmASK YOURSELF: Are we contracted with the plan? IF SO, WHAT IS THE EXPECTED REIMBURSEMENT? What date was the claim... View more
CA HMO Script – No Contract Underpayment
August 30, 2020 6:54 pmASK YOURSELF: What date was the claim initially billed? When did the plan underpay the claim? Did they underpay the... View more