PA HMO Affidavit – Notice Requirements for Adverse Determinations
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: PA 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 28 Pa. Code §9.705(c)(1)(vi), which... View more
PA HMO Affidavit – Poststabilization Timeframe
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: PA 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 28 Pa. Code §9.753(a), which state: (a) ... View more
PA HMO Affidavit – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: PA 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 40 PA.C.S §3803(a-b), which states: (a) General rule.–Except... View more
PA HMO Affidavit – Untimely Payment
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: PA 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 40 P.S §991.2166(a), which states:... View more
PA HMO Appeal – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: PA HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Pennsylvania Insurance Department for ‘s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per 40 P.S §991.2166(a), was required to reimburse this claim “…within... View more
PA HMO Appeal – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: PA HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Pennsylvania Insurance Department for ’s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: Under existing Colorado law, has a duty to provide all Maternity-covered services... View more
PA HMO Appeal – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: PA HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Pennsylvania Insurance Department 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 a... View more
PA HMO Appeal – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: PA HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Pennsylvania Insurance Department for ‘s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: 40 P.S §991.2102 defines “emergency services and care” as: Any health care service provided to an enrollee after... View more
PA HMO Appeal – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: PA HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Pennsylvania Insurance Department 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
PA HMO Appeal – Notice Requirements for Adverse Determinations
Last Updated: October 15, 2021 | Letter Type: Appeals | Jurisdiction: PA HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Pennsylvania Insurance Department 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 date,... View more