NV HMO Affidavit – Notice Requirements for Adverse Determinations
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: NV HMO
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 Health Plan or Contracted Entity has met the provisions of NV Rev Stat §695G.230(2), which... View more
NV HMO Affidavit – Untimely Payment
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: NV 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 NV Rev Stat §695C.185(1),... View more
NV HMO Appeal – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: NV HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Nevada Division 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 NV Rev Stat §695C.185(1), was required to “approve or... View more
NV HMO Appeal – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: NV HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nevada Division of Insurance for ‘s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: Under existing Nevada law, has a duty to provide all... View more
NV HMO Appeal – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: NV HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nevada Division 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
NV HMO Appeal – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: NV HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nevada Division of Insurance for ‘s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: NV Rev Stat §695G.170(3) defines “emergency services and care” as: (3) As used in this section, “medically... View more
NV HMO Appeal – Notice Requirements for Adverse Determinations
Last Updated: October 15, 2021 | Letter Type: Appeals | Jurisdiction: NV HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Nevada Division 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
NV HMO Appeal – Untimely Payment
Last Updated: October 15, 2021 | Letter Type: Appeals | Jurisdiction: NV HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Nevada Division of Insurance 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 NV Rev Stat §695C.185(1), was... View more
NY HMO Affidavit – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: NY HMO
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
NY HMO Affidavit – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: NY HMO
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 Health Plan or Contracted Entity has met the provisions of NY Ins L... View more