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
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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
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
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