TX HMO Appeal – Poststabilization Timeframe
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: TX HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Texas Department of Insurance 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
TX HMO Appeal – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: TX HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Texas 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 meet the written requirements set forth in 6... View more
TX HMO Appeal – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: TX HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Texas 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 6 TIC §843.348(g) states: (g) If the health maintenance... View more
TX HMO Appeal – Untimely Payment
Last Updated: May 5, 2021 | Letter Type: Appeals | Jurisdiction: TX HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Texas 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 6 TIC §843.338, was required to reimburse this claim “no... View more
VHA Affidavit – Interest Owed on Late Claims
Last Updated: November 23, 2021 | Letter Type: Affidavits | Jurisdiction: VHA
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 VA Facility/VISN has met the provisions of 31 U.S.C §3902, which states: (a)... View more
VHA Affidavit – Maternity Coverage
Last Updated: November 23, 2021 | Letter Type: Affidavits | Jurisdiction: VHA
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 VA Facility/VISN has met the provisions of 38 CFR §17.38(a) which states: The following hospital, outpatient,... View more
VHA Affidavit – Medical Necessity – Qualified Reviewers
Last Updated: November 23, 2021 | Letter Type: Affidavits | Jurisdiction: VHA
AFFIDAVIT OF COMPLIANCE Medical Necessity 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 VA Facility/VISN has met the provisions of 38 CFR §17.1006, which states: “The Chief of the Health... View more
VHA Affidavit – No Authorization for ER Services and Care
Last Updated: November 23, 2021 | Letter Type: Affidavits | Jurisdiction: VHA
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 VA Facility/VISN has met the provisions of 38 CFR §17.120 and 38 U.S.C... View more
VHA Affidavit – Notice Requirements for Adverse Determinations
Last Updated: November 23, 2021 | Letter Type: Affidavits | Jurisdiction: VHA
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 VA Facility/VISN has met the provisions of 38 CFR §17.1006 and 38 CFR §17.132... View more
VHA Affidavit – Poststabilization Timeframe
Last Updated: November 23, 2021 | Letter Type: Affidavits | Jurisdiction: VHA
AFFIDAVIT OF COMPLIANCE Post-Stabilization 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 VA Facility/VISN has met the provisions of 38 CFR §17.54(a), which states: (a) The admission... View more