MA Affidavit – Non-urgent Authorization Timeframes (FREE DEMO)
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: MA
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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of... View more
MA Affidavit – Untimely Payment (FREE DEMO)
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: MA
AFFIDAVIT OF COMPLIANCE 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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of 42 CFR §422.520 (a),... View more
MA Appeal – Maternity Coverage (FREE DEMO)
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: MA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Centers for Medicare and Medicaid Services (CMS) for ’s failure to provide coverage for maternity services and care as required by Federal law. Our investigation has concluded the following: Under existing Federal Law, 42 CR §422.101(b)(1-2), Medicare... View more
MA Appeal – Non-urgent Authorization Timeframes (FREE DEMO)
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: MA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Centers for Medicare and Medicaid Services (CMS) for ’s failure to meet the timeframe and notice requirements for non-urgent authorization requests as required by Federal law. Our investigation has concluded the following: THIS REQUEST IS NOW DAYS... View more
MA Appeal – Untimely Payment (FREE DEMO)
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: MA
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Centers for Medicare and Medicaid Services (CMS) for ’s failure to reimburse health services as required by Federal law. Our investigation has concluded the following: In a recent audit, it has come to our attention that... View more
AL HMO Affidavit – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: AL 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
AL HMO Affidavit – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: AL 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 Ala. Code §27-48-2,... View more
AL HMO Affidavit – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: AL HMO
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 Health Plan or Contracted Entity has met the provisions of... View more
AL HMO Affidavit – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: AL 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 the provisions of Ala. Code §27-3A-5(a)(1), which... View more
AL HMO Affidavit – Notice Requirements for Adverse Determinations
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: AL 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