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
WA HMO Appeal – Medical Necessity – Qualified Reviewers
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 reimburse medically necessary services as required by State law. Our investigation has concluded the following: Please be aware that Washington Administrative Code 284-43-3110(6) states: (6) Review of... View more
WA HMO Appeal – No Authorization for ER Services and Care
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 reimburse emergency services as required by State law. Our investigation has concluded the following: Per Revised Codes of Washington (RCW) 48.43.093(1)(a): (1)(a) A health carrier shall cover... View more
WA HMO Appeal – Non-urgent Authorization Timeframes
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 Washington Office of the Insurance Commissioner (OIC) 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... View more
WA HMO Appeal – Notice Requirements for Adverse Determinations
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 reimburse medically necessary services as required by State law. Our investigation has concluded the following: On , denied this claim as not medically necessary. To date, we... View more
WA HMO Appeal – Poststabilization Timeframe
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 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... View more
WA HMO Appeal – Refund Recoupment
Last Updated: January 22, 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 recoupment of payment for properly reimbursed medically necessary services as required by State law. Our investigation has concluded the following: Please be advised that must meet the written requirements... View more