CA HMO Appeal – Medical Necessity – Qualified Reviewers
August 28, 2020 6:42 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of... View more
Archives
CA HMO Appeal – Maternity Coverage
August 28, 2020 6:40 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of... View more
CA HMO Appeal – Interest Owed on Late Claims
August 28, 2020 6:33 pmURGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Department... View more
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
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