VHA Affidavit – Retroactive Denial for Authorized Care
Last Updated: November 23, 2021 | Letter Type: Affidavits | Jurisdiction: VHA
AFFIDAVIT OF COMPLIANCE Retroactive Denials for Authorized Care 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 §17.52(a) and 38 CFR... View more
VHA Appeal – Interest Owed on Late Claims
Last Updated: November 23, 2021 | Letter Type: Appeals | Jurisdiction: VHA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the VA Under Secretary for Health for the VA’s failure to properly reimburse emergency and/or authorized medically necessary services and care as required by federal law. Per the VA website, “the VA must make every effort to adjudicate... View more
VHA Appeal – Maternity Coverage
Last Updated: November 23, 2021 | Letter Type: Appeals | Jurisdiction: VHA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the VA Under Secretary for Health for the VA’s failure to provide coverage for maternity services and care as required by Federal law. Our investigation has concluded the following: The VA has a duty to provide all maternity-covered... View more
VHA Appeal – Medical Necessity – Qualified Reviewers
Last Updated: November 23, 2021 | Letter Type: Appeals | Jurisdiction: VHA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the VA Under Secretary for Health for the VA’s failure to reimburse medically necessary services as required by Federal law. Our investigation has concluded the following: Please be advised that 38 CFR §17.1006 states: “The Chief of the... View more
VHA Appeal – No Authorization for ER Services and Care
Last Updated: November 23, 2021 | Letter Type: Appeals | Jurisdiction: VHA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the VA Under Secretary for Health for the VA’s failure to reimburse emergency services as required by Federal law. Our investigation has concluded the following: As you are aware, “to the extent allowable the VA will issue payment... View more
VHA Appeal – Notice Requirements for Adverse Determinations
Last Updated: November 23, 2021 | Letter Type: Appeals | Jurisdiction: VHA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the VA Under Secretary for Health for the VA’s failure to reimburse medically necessary services as required by Federal law. Our investigation has concluded the following: Please be advised that 38 CFR §17.1006 states: “The Chief of the... View more
VHA Appeal – Poststabilization Timeframe
Last Updated: November 23, 2021 | Letter Type: Appeals | Jurisdiction: VHA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the VA Under Secretary for Health for the VA’s failure to reimburse post-stabilization services as required by Federal law. Our investigation has concluded the following: THIS CLAIM IS NOW DAYS IN VIOLATION OF THE STATUTORY TIMEFRAMES. The VA... View more
VHA Appeal – Retroactive Denial for Authorized Care
Last Updated: November 23, 2021 | Letter Type: Appeals | Jurisdiction: VHA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the VA Under Secretary for Health for the VA’s failure to reimburse authorized services and care as required by Federal law. Our investigation has concluded the following: Under existing federal law, the VA has a duty to reimburse... View more