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Found 211 Letters.

CA HMO Affidavit – Maternity (FREE DEMO)

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Maternity Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Licensed Plan or Contracted Entity has met the provisions of Health and Safety Code §1367.62(a) which... View more

CA HMO Affidavit – Auth Timeframe – Non-urgent

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Timeframes for Authorization Requests – Non-Urgent Health Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS:   I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of... View more

CA HMO Affidavit – COB Denial

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Coordination of Benefits Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(h)(3) and 28 CCR... View more

CA HMO Affidavit – Concurrent Disagreement of Care

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Disagreement of Post-Stabilization Care Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of Health & Safety Code §1371.4(d)... View more

CA HMO Affidavit – Denial of Timely Billed Claims

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: September 5, 2020

AFFIDAVIT OF COMPLIANCE Denial of Timely Billed Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(b)(1) and... View more

CA HMO Affidavit – Good Cause for Untimely Billed Claims

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: September 5, 2020

AFFIDAVIT OF COMPLIANCE Good Cause for Untimely Billed Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(b)(1)... View more

CA HMO Affidavit – Interest Owed

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Interest Owed on Late Claims Incorporated by Reference in 28 US Code § 1746  Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(i), which... View more

CA HMO Affidavit – LA City Underpaid Non-Contracted Ambulance Transport

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Expected Reimbursement for L.A. City Non-Contracted Ambulance Transport Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of... View more

CA HMO Affidavit – Med Nec Qualified Reviewer

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Medical Necessity Competent Reviewer Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Plan or Contracted Entity has met the provisions of Health and Safety Code §1370.2,... View more

CA HMO Affidavit – Misdirected

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Misdirected Claim Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients:         DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Knox-Keene Licensed Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(b)(2-3), which states: (2)... View more