CO HMO Affidavit – Notice Requirements for Adverse Determinations
Last Updated: May 4, 2021 | Letter Type: Affidavits | Jurisdiction: CO HMO
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 Plan or Contracted Entity has met the provisions of... View more
CO HMO Affidavit – Poststabilization Timeframe
Last Updated: October 8, 2021 | Letter Type: Affidavits | Jurisdiction: CO HMO
AFFIDAVIT OF COMPLIANCE Poststabilization Care 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 Plan or Contracted Entity has met the provisions of CO Rev.... View more
CO HMO Affidavit – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CO HMO
AFFIDAVIT OF COMPLIANCE Refund 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 Plan or Contracted Entity has met the provisions of CO Rev. Stat.... View more
CO HMO Affidavit – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CO HMO
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 Plan or Contracted Entity has met the provisions of... View more
CO HMO Affidavit – Untimely Payment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CO HMO
AFFIDAVIT OF COMPLIANCE Prompt Payment to Providers 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 Plan or Contracted Entity has met the provisions of CO... View more
CO HMO Appeal – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per CO Rev. Stat §10-16-106.5(4)(a), was required to reimburse this... View more
CO HMO Appeal – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: As you may know, CO Rev. Stat. §10-16-704(5.5)(b)(I)(A) states: (I) ”Emergency medical... View more
CO HMO Appeal – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that our treating physician was a . However, your reviewer was... View more
CO HMO Appeal – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: CO Rev. Stat. §10-16-704(5.5)(b)(II)(A-B) defines “emergency services and care” as: (A) A medical screening examination that is... View more
CO HMO Appeal – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to meet the timeframe and notice requirements for non-urgent authorization requests as required by state law. Our investigation has concluded the following: THIS REQUEST IS NOW DAYS IN VIOLATION OF... View more