WA HMO Affidavit – Medical Necessity – Qualified Reviewers
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA HMO
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 below Plan or Contracted Entity has met the provisions of Washington Administrative Code 284-43-3110(6),... View more
WA HMO Affidavit – No Authorization for ER Services and Care
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA HMO
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 Plan or Contracted Entity has met the provisions of Revised Codes... View more
WA HMO Affidavit – Non-urgent Authorization Timeframes
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA HMO
AFFIDAVIT OF COMPLIANCE Timeframes for Authorization Requests – Non-Urgent Health 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 Plan or Contracted Entity has met the... View more
WA HMO Affidavit – Notice Requirements for Adverse Determinations
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA 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 Plan or Contracted Entity has met the provisions of Washington Administrative... View more
WA HMO Affidavit – Poststabilization Timeframe
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA 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 Plan or Contracted Entity has met the provisions of Revised Code of Washington §48.43.093,... View more
WA HMO Affidavit – Refund Recoupment
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA HMO
AFFIDAVIT OF COMPLIANCE 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 Plan or Contracted Entity has met the provisions of Revised Code of Washington (RCW)... View more
WA HMO Affidavit – Retroactive Denial for Authorized Care
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA HMO
AFFIDAVIT OF COMPLIANCE Retroactive Denial of Authorized 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 Plan or Contracted Entity has met the provisions of Revised Code of Washington §48.43.525 which states: (1)... View more
WA HMO Affidavit – Untimely Payment
Last Updated: January 21, 2025 | Letter Type: Affidavits | Jurisdiction: WA 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 Plan or Contracted Entity has met the provisions of Washington Administrative Code... View more
WA HMO Appeal – Interest Owed on Late Claims
Last Updated: January 21, 2025 | Letter Type: Appeals | Jurisdiction: WA HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Washington Office of the Insurance Commissioner (OIC) for ’s failure to remit automatic interest accrued on this claim as required by State law. Our investigation has concluded the following: Prompt reimbursement of a claim is defined... View more
WA HMO Appeal – Maternity Coverage
Last Updated: January 21, 2025 | Letter Type: Appeals | Jurisdiction: WA HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Office of the Insurance Commissioner (OIC) for ’s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: As you may know Revised Code of Washington (RCW)... View more