NY HMO Appeal – Notice Requirements for Adverse Determinations
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: NY HMO
URGENT-IMPERATIVE-ACTION Dear Director of : This office has been asked to file a formal complaint with the NY Department of Financial Services for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: On , denied this claim as not medically necessary. To date, we have not received... View more
NY HMO Appeal – Poststabilization Timeframe
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: NY HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the NY Department of Financial Services for ’s failure to reimburse emergency and/or statutorily authorized 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
NY HMO Appeal – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: NY HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the NY Department of Financial Services 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 meet the written requirements set forth in NY... View more
NY HMO Appeal – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: NY HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the NY Department of Financial Services for ’s failure to reimburse authorized health services as required by state law. On , authorization number was issued by . Please be advised NY Ins L §3238(a) states: (a) An insurer, corporation... View more
NY HMO Appeal – Untimely Payment
Last Updated: May 5, 2021 | Letter Type: Appeals | Jurisdiction: NY HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the NY Department of Financial Services for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per NY Ins L §3224-a(a), was required to reimburse... View more
OH HMO Affidavit – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: OH HMO
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 Health Plan or Contracted Entity has met the provisions of Ohio... View more
OH HMO Affidavit – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: OH HMO
AFFIDAVIT OF COMPLIANCE Timeframes for Authorization Requests – Non-Urgent Health 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 Ohio... View more
OH HMO Affidavit – Poststabilization Timeframe
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: OH HMO
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 Health Plan or Contracted Entity has met the provisions of Ohio Rev Code §3923.041(B)(4)(a), which states:... View more
OH HMO Affidavit – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: OH HMO
AFFIDAVIT OF COMPLIANCE Refund Recoupment 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 Ohio Rev Code §3901.388(A,C), which states: (A) A payment made... View more
OH HMO Affidavit – Untimely Payment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: OH 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 Ohio Rev... View more