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Found 378 Letters.

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

OH HMO Appeal – No Authorization for ER Services and Care

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: OH HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Ohio Department of Insurance for ‘s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: As the services rendered were emergent, was not required to obtain authorization per Ohio Rev... View more

OH HMO Appeal – Non-urgent Authorization Timeframes

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: OH HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Ohio 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

OH HMO Appeal – Poststabilization Timeframe

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: OH HMO

IMPERATIVE-ACTION REQUIRED   Dear Director of : This office has been asked to file a formal complaint with the Ohio 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... View more

OH HMO Appeal – Refund Recoupment

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: OH HMO

  IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Ohio 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 how it reached its overpayment determination... View more

OH HMO Appeal – Untimely Payment

Last Updated: October 15, 2021 | Letter Type: Appeals | Jurisdiction: OH HMO

URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Ohio Department of Insurance for ‘s failure to remit timely payment on this claim as required by state law. Our investigation has concluded the following: Per Ohio Rev Code §3901.381(B)(1), was required to reimburse within the... View more

PA HMO Affidavit – Interest Owed on Late Claims

Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: PA 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 40 P.S §991.2166(b), which... View more

PA HMO Affidavit – Maternity Coverage

Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: PA 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 31 Pa. Code §154.12(a), which states: (a)... View more