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Found 378 Letters.

MA Affidavit – Interest Owed on Late Claims

Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: MA

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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of 42 CFR §422.520,... View more

MA Affidavit – Maternity Coverage

Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: MA

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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of 45 CFR §146.130(a) which states:... View more

MA Affidavit – Medical Necessity – Qualified Reviewers

Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: MA

AFFIDAVIT OF COMPLIANCE Medical Necessity 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 §422.590, which states:... View more

MA Affidavit – Misdirected Claims

Last Updated: May 24, 2020 | Letter Type: Affidavits | Jurisdiction: MA

AFFIDAVIT OF COMPLIANCE Misdirected Claim 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 §422.504(i), which states:... View more

MA Affidavit – No Authorization for ER Services and Care

Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: MA

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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of 42 CFR... View more

MA Affidavit – No Claim on File

Last Updated: May 23, 2020 | Letter Type: Affidavits | Jurisdiction: MA

AFFIDAVIT OF COMPLIANCE No Claim on File 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 45 CFR §164.530(c),... View more

MA Affidavit – No Contract Underpayment

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

AFFIDAVIT OF COMPLIANCE Payment to Non-Contract 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 §422.216... View more

MA Affidavit – Notice Requirements for Adverse Determinations

Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: MA

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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of 42 CFR... View more

MA Affidavit – Poststabilization Timeframe

Last Updated: May 23, 2020 | Letter Type: Affidavits | Jurisdiction: MA

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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of 42 CFR §422.113(c), which... View more

MA Affidavit – Refund Recoupment – Reducing LOC

Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: MA

AFFIDAVIT OF COMPLIANCE Recoupment-Reducing LOC 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 Medicare Managed Care Manual, Chapter... View more