AL HMO Appeal – Untimely Payment
Last Updated: October 7, 2021 | Letter Type: Appeals | Jurisdiction: AL HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Alabama Department of Insurance for ’s failure to remit timely payment and automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: was required to reimburse this claim within... View more
CA HMO Affidavit – COB Denial
Last Updated: August 29, 2020 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Coordination of Benefits 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 Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(h)(3) and 28 CCR... View more
CA HMO Affidavit – Concurrent Disagreement of Care
Last Updated: August 29, 2020 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Disagreement of Post-Stabilization 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 Knox-Keene Plan or Contracted Entity has met the provisions of Health & Safety Code §1371.4(d)... View more
CA HMO Affidavit – Contract Underpayment
Last Updated: November 19, 2021 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Expected Reimbursement for Contracted 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 Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(a)(3)(A) which... View more
CA HMO Affidavit – Denial of Timely Billed Claims
Last Updated: September 5, 2020 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Denial of Timely Billed 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 Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(b)(1) and... View more
CA HMO Affidavit – General Ambulance Transport No Contract Underpayment
Last Updated: December 21, 2024 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Expected Reimbursement for Non-Contracted Ambulance Transport Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, reviewed, and verified all pertinent records relating to the claim(s). I also certify that I maintain on file evidence that the below... View more
CA HMO Affidavit – Good Cause for Untimely Billed Claims
Last Updated: September 5, 2020 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Good Cause for Untimely Billed 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 Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(b)(1)... View more
CA HMO Affidavit – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: CA 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 Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(i), which... View more
CA HMO Affidavit – LA City Ambulance Transport No Contract Underpayment
Last Updated: December 17, 2024 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Expected Reimbursement for L.A. City Non-Contracted Ambulance Transport Claims Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, reviewed, and verified all pertinent records relating to the claim(s). I also certify that I maintain on file evidence that... View more
CA HMO Affidavit – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: CA HMO
AFFIDAVIT OF COMPLIANCE Medical Necessity Competent Reviewer 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 Knox-Keene Plan or Contracted Entity has met the provisions of Health and Safety Code §1370.2,... View more