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Found 373 Letters.

MA Appeal – Timely Payment (FREE DEMO)

Letter Type: Affidavits | Jurisdiction: MA | Last Updated: August 31, 2020

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

MA Appeal – No Claim on File

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

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 – Notice Requirements

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

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 – Post-Stabilization

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

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 timely authorization for medically necessary poststabilization services and care as required by Federal law. Our investigation has concluded the following: THIS CLAIM IS NOW DAYS... View more

MA Appeal – Recoupment-Reducing LOC

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

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 properly reimburse medically necessary services as required by Federal law. Our investigation has concluded the following: Pursuant to the Medicare Managed Care Manual, Chapter 4, Section... View more

MA Appeal – Retroactive Denial for Authorized Care

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

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 authorized health services as required by Federal law. Our investigation has concluded the following: Pursuant to the Medicare Managed Care Manual, Chapter 4, Section 10.16:... View more

MA Appeal – Underpaid Contracted

Letter Type: Affidavits | Jurisdiction: MA | Last Updated: October 26, 2021

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 – Underpaid Non-Contracted

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

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 – Untimely Filing

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

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 timely billed health services as required by Federal law. Our investigation has concluded the following: As you know, per 42 CFR § 424.44(a), claims... View more

MI HMO Affidavit – Interest Owed

Letter Type: Affidavits | Jurisdiction: MI HMO | Last Updated: October 13, 2021

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