CA PPO Affidavit – Untimely Filing
November 22, 2021 9:22 pmAFFIDAVIT OF COMPLIANCE Denial of Timely Billed Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: ... View more
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CA PPO Script – Patient not Eligible
August 30, 2020 11:06 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation... View more
CA PPO Script – Untimely Filing
August 30, 2020 11:02 pmASK YOURSELF: Is this claim or appeal “truly” filed late or has the plan mishandled the initial timely submission of... View more
CA PPO Script – Untimely Payment
August 30, 2020 10:57 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
CA PPO Script – Retroactive Denial for Authorized Care
August 30, 2020 10:56 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation... View more
CA PPO Script – Refund Recoupment
August 30, 2020 10:49 pmASK YOURSELF: How many days after payment, did the insurer request the refund? Why did the plan request the money... View more
CA PPO Script – Notice Requirements for Adverse Determinations
August 30, 2020 10:45 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
CA PPO Script – No Authorization for ER Services and Care
August 30, 2020 10:41 pmASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
CA PPO Script – Medical Necessity – Qualified Reviewers
August 30, 2020 10:37 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more
CA PPO Script – Maternity Coverage
August 30, 2020 10:33 pmASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more