MA Affidavit – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: MA
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 Medicare Advantage Organization/Plan or Contracted Entity has met the provisions of Medicare Managed... View more
MA Affidavit – Untimely Filing
Last Updated: May 23, 2020 | Letter Type: Affidavits | Jurisdiction: MA
AFFIDAVIT OF COMPLIANCE Denial of Timely Billed 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
MA Appeal – Contract Underpayment
Last Updated: November 19, 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 properly reimburse health services as required by Federal law. Our investigation has concluded the following: Pursuant to 42 CFR § 422.520(b): (1) Contracts between MA organizations... View more
MA Appeal – Interest Owed on Late Claims
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 safeguard and process the claim, as required by Federal law. Prompt reimbursement of a claim is defined under 42 CFR §422.520(a): (a) Contract between CMS and... View more
MA Appeal – Medical Necessity – Qualified Reviewers
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 reimburse medically necessary services as required by Federal law. Our investigation has concluded the following: Please be advised that 42 CFR §422.566(d) states: If the MA... View more
MA Appeal – Misdirected Claims
Last Updated: May 24, 2020 | 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 medically necessary services as required by Federal law. Our investigation has concluded the following: Pursuant to 42 CFR §422.504(i), regardless of the relationship may... View more
MA Appeal – No Authorization for ER Services and Care
Last Updated: November 20, 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 reimburse emergency services as required by Federal law. Our investigation has concluded the following: As you are aware, an MA organization is financially responsible for emergency... View more
MA Appeal – No Claim on File
Last Updated: May 23, 2020 | 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 safeguard and process the claim, as required by Federal law. Prompt reimbursement of a claim is defined under 42 CFR §422.520(a): (a) Contract between CMS... View more
MA Appeal – No Contract Underpayment
Last Updated: November 19, 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 properly reimburse health services as required by Federal law. Our investigation has concluded the following: Pursuant to 42 CFR § 422.216(a) (3) Noncontract providers. The... View more
MA Appeal – Notice Requirements for Adverse Determinations
Last Updated: April 6, 2022 | 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 reimburse medically necessary services as required by Federal law. Our investigation has concluded the following: Please be advised that 42 CFR §422.566(d) states: If the MA... View more