CA HMO Script – Untimely Filing
August 30, 2020 6:46 pmASK YOURSELF: Is this claim or appeal “truly” filed late or has the plan mishandled the initial timely submission of... View more
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CA HMO Script – Untimely Payment
August 30, 2020 6:11 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 – Retroactive Denial for Authorized Care
August 30, 2020 6:08 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 – Refund Recoupment
August 30, 2020 5:50 pmASK 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 – Notice Requirements for Adverse Determinations
August 30, 2020 5:50 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
CA HMO Script – No Authorization for ER Services and Care
August 30, 2020 5:36 pmASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
CA HMO Script – Medical Necessity – Qualified Reviewers
August 30, 2020 5:02 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
CA HMO Script – Maternity Coverage
August 30, 2020 4:55 pmASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more
CA HMO Script – Interest Owed on Late Claims
August 30, 2020 4:52 pmASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did they pay this claim... View more
CA HMO Script – Non-urgent Authorization Timeframes
August 30, 2020 4:49 pmASK YOURSELF: What date was the request for non-urgent authorization made? Was there any written communication (request for information, denial,... View more