NE HMO Affidavit – Untimely Payment
Last Updated: September 10, 2025 | Letter Type: Affidavits | Jurisdiction: NE 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 Neb. Rev.... View more
NE HMO Appeal – Interest Owed on Late Claims
Last Updated: September 8, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per Neb. Rev. St. § 44-8005, is required to pay... View more
NE HMO Appeal – Maternity Coverage
Last Updated: September 8, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance for ’s failure to provide coverage for maternity services and care as required by federal law. Our investigation has concluded the following: Under The Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA),... View more
NE HMO Appeal – Medical Necessity – Qualified Reviewers
Last Updated: September 11, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that our treating physician was a . However, your reviewer was... View more
NE HMO Appeal – No Authorization for ER Services and Care
Last Updated: September 8, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance for ’s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: Neb. Rev. St §44-6827 defines “emergency services” as: (6) “…health care services necessary to screen... View more
NE HMO Appeal – Non-urgent Authorization Timeframes
Last Updated: September 8, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance 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... View more
NE HMO Appeal – Notice Requirements for Adverse Determinations
Last Updated: September 8, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance 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... View more
NE HMO Appeal – Poststabilization Timeframe
Last Updated: September 11, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance 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... View more
NE HMO Appeal – Refund Recoupment
Last Updated: September 8, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance 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 clear, documented evidence of an overpayment and... View more
NE HMO Appeal – Retroactive Denial for Authorized Care
Last Updated: September 8, 2025 | Letter Type: Appeals | Jurisdiction: NE HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nebraska Department of Insurance for ’s failure to reimburse authorized health services as required by state law. On , authorization number was issued by . Please be advised The Ensuring Transparency in Prior Authorization Act (9)(2);(10)(2)(a), effective... View more