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
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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
CA HMO Affidavit – Concurrent Disagreement of Care
August 29, 2020 5:04 pmAFFIDAVIT OF COMPLIANCE Disagreement of Post-Stabilization Care Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
CA HMO Affidavit – Uncontested Portion of Claim
August 29, 2020 4:59 pmAFFIDAVIT OF COMPLIANCE Denial of Uncontested Portion of Claim Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:... View more
CA HMO Affidavit – COB Denial
August 29, 2020 4:52 pmAFFIDAVIT OF COMPLIANCE Coordination of Benefits Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
CA HMO Affidavit – Overpayment Offset
August 29, 2020 4:49 pmAFFIDAVIT OF COMPLIANCE Overpayment Offset Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
CA HMO Affidavit – Request for Insignificant Information
August 29, 2020 4:48 pmAFFIDAVIT OF COMPLIANCE Request for Insignificant Information Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more