FL HMO Appeal – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to properly reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that must meet the written requirements set forth in... View more
FL HMO Appeal – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to reimburse authorized health services as required by state law. On , authorization number was issued by . Please be advised 37 Fla. Stat. §641.3156 (1-2) states: (1) A health... View more
FL HMO Appeal – Untimely Payment
Last Updated: May 4, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to timely reimburse this claim and remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per 37 Fla. Stat. §627.613(2),... View more
GA HMO Affidavit – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: GA HMO
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 Health Plan or Contracted Entity has met the provisions of GA Code §33-24-59.14(c), which states:... View more
GA HMO Affidavit – Maternity Coverage
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: GA HMO
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 Health Plan or Contracted Entity has met the provisions of GA Code §33-24-58.2(b-c), which states: (b) Every... View more
GA HMO Affidavit – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: GA HMO
AFFIDAVIT OF COMPLIANCE Emergency and Urgently Needed 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 GA Code §33-21-18.1 which states:... View more
GA HMO Affidavit – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: GA 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 GA Code §33-20A-62(a-b), which states: (a) No carrier,... View more
GA HMO Affidavit – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: GA 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 GA Code §33-20A-7.1(b), which... View more
GA HMO Affidavit – Untimely Payment
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: GA 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 GA Code §33-24-59.14(b)(1), which states: (b)(1) All... View more
GA HMO Appeal – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: GA HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Georgia 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 GA Code §33-24-59.14(b)(1), was required to reimburse this claim... View more