WA HMO Appeal – Retroactive Denial for Authorized Care
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 failure to reimburse authorized health services as required by State law. Our investigation has concluded the following: On , authorization number was issued by . Please be advised Revised... View more
WA HMO Appeal – Untimely Payment
Last Updated: January 22, 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 Office of the Insurance Commissioner (OIC) for ’s failure to timely reimburse this claim as required by State law. Prompt reimbursement of a claim is defined under Washington Administrative Code (WAC) 284-170-431(2)(a): (2)(a) For health services... View more
WA HMO Fax Cover Sheet – Competent Reviewer Request
Last Updated: December 30, 2024 | Letter Type: Fax Cover Sheets | Jurisdiction: WA HMO
COMPETENT REVIEWER REQUEST : Washington law requires that there is a right to request the identity of the experts who were consulted about the adverse benefit determination—even if the expert’s advice was not used to make the determination, per WAC 284-43-3070. The carrier must provide, at minimum, the expert’s... View more
WA HMO Fax Cover Sheet – Request for Authorization of Post-stabilization Services
Last Updated: December 30, 2024 | Letter Type: Fax Cover Sheets | Jurisdiction: WA HMO
REQUEST FOR AUTHORIZATION TO PROVIDE POST-STABILIZATION SERVICES : Federal regulations require that you (1) provide post-stabilization authorization, or (2) enter into a disagreement of care and arrange for the transfer of the patient within 60 minutes from receipt of this notification, per 42 CFR §422.113 and 42 CFR §... View more