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Found 378 Letters.

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

KS HMO Appeal – No Authorization for ER Services and Care

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: KS HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance Department for ’s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: KS Stat §40-4602(b) defines “emergency services and care” as: (b) “Emergency services” means ambulance services and health... View more

KS HMO Appeal – Non-urgent Authorization Timeframes

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: KS HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance Department 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 THE... View more

KS HMO Appeal – Notice Requirements for Adverse Determinations

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: KS HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance Department for ’s failure to reimburse medically necessary services and meet notice requirements as required by state law. Our investigation has concluded the following: On , denied this claim as not medically necessary. To date,... View more

KS HMO Appeal – Poststabilization Timeframe

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: KS HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance Department for ’s failure to reimburse emergency and/or statutorily granted post-stabilization services and care as required by state law. Our investigation has concluded the following: TO DATE, HAS FAILED TO REIMBURSE EMERGENCY AND STATUTORILY AUTHORIZED... View more

KS HMO Appeal – Refund Recoupment

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: KS HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance Department 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 substantiate how it reached its overpayment determination and identify... View more

KS HMO Appeal – Untimely Payment

Last Updated: November 20, 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 timely payment and 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... View more

MA Affidavit – Contract Underpayment

Last Updated: November 19, 2021 | Letter Type: Affidavits | Jurisdiction: MA

AFFIDAVIT OF COMPLIANCE Expected Reimbursement for Contracted 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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of 42 CFR... View more