CA HMO Appeal – Non-urgent Authorization Timeframes
August 28, 2020 6:20 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of... View more
Archives
Health & Safety Code §1371.4(d)
August 28, 2020 5:57 pmIf there is a disagreement between the health care service plan and the provider regarding the need for necessary medical... View more
Health & Safety Code §1371.37(c)(3)
August 28, 2020 5:57 pm(c)(3) An “unfair payment pattern,” as used in this section, means any of the following: (3) Failing on a repeated basis... View more
Health & Safety Code §1371(a)(1)
August 28, 2020 5:51 pm(a)(1) A health care service plan, including a specialized health care service plan, shall reimburse each complete claim, or portion... View more
28 CCR §1300.67.13(a)(2-3)
August 28, 2020 5:50 pm(2) A COB provision may not relieve a plan of a duty otherwise arising from a plan contract to deliver... View more
28 CCR §1300.71(h)(3)
August 28, 2020 5:50 pm28 CCR §1300.71(h)(3): A request for information necessary to determine payer liability from a third party shall not extend the... View more
28 CCR §1300.71(d)(6)
August 28, 2020 5:49 pmA plan or a plan’s capitated provider may only offset an uncontested notice of reimbursement of the overpayment of a... View more
28 CCR §1300.71(a)(10)
August 28, 2020 5:49 pm“Reasonably relevant information” means the minimum amount of itemized, accurate and material information generated by or in the possession of... View more
Lauderdale Associates d.b.a. Alhambra Convalescent Hosp. v. California Department of Health Service Cal App 1d AO80227 (1998)
August 28, 2020 5:48 pmLauderdale Associates d.b.a. Alhambra Convalescent Hosp. v. California Department of Health Service Cal App 1d AO80227 (1998): “Health plans cannot... View more
Health & Safety Code §1371.36(a)
August 28, 2020 5:48 pm(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical... View more