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
Archives
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
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
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