IN HMO Appeal – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to reimburse authorized health services as required by state law. On , authorization number was issued by . Please be advised IN Code §27-1-37.5-12(b) states: (b) The health plan shall... View more
IN HMO Appeal – Untimely Payment
Last Updated: October 10, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to remit timely payment and automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per IN Code §27-8-5.7-6(a), was required to reimburse... View more
KS HMO Affidavit – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: KS 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... View more
KS HMO Affidavit – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: KS 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... View more
KS HMO Affidavit – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: KS HMO
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 Plan or Contracted Entity has met... View more
KS HMO Affidavit – Notice Requirements for Adverse Determinations
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: KS 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
KS HMO Affidavit – Poststabilization Timeframe
Last Updated: October 10, 2021 | Letter Type: Affidavits | Jurisdiction: KS 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 KS Stat... View more
KS HMO Affidavit – Refund Recoupment
Last Updated: October 10, 2021 | Letter Type: Affidavits | Jurisdiction: KS 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 KS Stat §40-2442(f),... View more
KS HMO Affidavit – Untimely Payment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: KS 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 KS... View more
KS HMO Appeal – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: KS HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance Department for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per KS Stat §40-2442(a), was required to reimburse this claim “within... View more