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Found 378 Letters.

CA PPO Affidavit – Non-urgent Authorization Timeframes

Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO

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 Health Insurer or Contracted Entity has met the provisions of Cal.... View more

CA PPO Affidavit – Notice Requirements for Adverse Determinations

Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO

AFFIDAVIT OF COMPLIANCE Notice Requirements for Adverse Determinations 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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §10123.135(h)(4),... View more

CA PPO Affidavit – Patient Not Eligible

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

AFFIDAVIT OF COMPLIANCE Patient Not Eligible 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 Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §796.04 and Cal. Ins.... View more

CA PPO Affidavit – Refund Recoupment

Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO

AFFIDAVIT OF COMPLIANCE Recoupment 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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §10123.145(a)(1) and Cal. Ins. Code... View more

CA PPO Affidavit – Retroactive Denial for Authorized Care

Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO

AFFIDAVIT OF COMPLIANCE Retroactive Denial of Authorized 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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §796.04,... View more

CA PPO Affidavit – Untimely Filing

Last Updated: November 22, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO

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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §10133.66(a),... View more

CA PPO Appeal – Interest Owed on Late Claims

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CA PPO

URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the California Department of Insurance (CDI) for ’s failure to remit automatic interest accrued on this claim as required by State law. Our investigation has concluded the following: Cal. Ins. Code §§10123.13 and 10123.147 (a) states: Every... View more

CA PPO Appeal – Medical Necessity – Qualified Reviewers

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CA PPO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the California Department of Insurance (CDI) for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised, Cal. Ins. Code §10123.135(e) states: An individual, other than a... View more

CA PPO Appeal – No Authorization for ER Services and Care

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: CA PPO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the California Department of Insurance (CDI) for ’s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: Cal. Ins. Code §10112.7(b)(1) defines “emergency services and care” as: A medical screening examination that... View more

CA PPO Appeal – Non-urgent Authorization Timeframes

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CA PPO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the California Department of Insurance (CDI) for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: THIS REQUEST IS NOW DAYS IN VIOLATION OF THE STATUTORY TIMEFRAMES. Under existing... View more