CA HMO Appeal – Untimely Filing
Last Updated: August 28, 2020 | Letter Type: Appeals | Jurisdiction: CA HMO
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Department of Managed Health Care (DMHC) for ’s failure to reimburse timely billed health services as required by state law. Our investigation has concluded the following: [SCENARIO 1: CLAIM WAS TIMELY FILED] Please be advised that... View more
CA HMO Appeal – Untimely Filing with Exceptional Circumstance
Last Updated: September 5, 2020 | Letter Type: Appeals | Jurisdiction: CA HMO
IMPERATIVE-ACTION REQUIRED Dear Director of Claims: This office has been asked to file a formal complaint with the Department of Managed Health Care (DMHC) for ’s failure to reimburse medically necessary services as required by State law. Our investigation has concluded the following: On , denied this claim for untimely filing. However, did not provide... View more
CA MEDI-CAL Affidavit – ETAR Authorization Timeframes
Last Updated: September 3, 2020 | Letter Type: Affidavits | Jurisdiction: Medi-Cal
AFFIDAVIT OF COMPLIANCE Timeframes for ETAR Authorization Requests 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 Medi-Cal has met the provisions of Welfare & Institutions Code §14133.9(d), which states: (d) When a proposed... View more
CA Medi-Cal Appeal – ETAR Authorization Timeframe
Last Updated: September 3, 2020 | Letter Type: Appeals | Jurisdiction: Medi-Cal
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of Health Care Services (DHCS) 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 IN... View more
CA PPO Affidavit – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO
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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §§10123.13... View more
CA PPO Affidavit – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO
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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §10123.135(e), which states: (e) An... View more
CA PPO Affidavit – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO
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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §10112.7(a)(1)... View more
CA PPO Affidavit – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO
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 Health Insurer or Contracted Entity has met the provisions of Cal.... View more
CA PPO Affidavit – Notice Requirements for Adverse Determinations
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: CA PPO
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 Health Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §10123.135(h)(4),... View more
CA PPO Affidavit – Patient Not Eligible
Last Updated: August 29, 2020 | Letter Type: Affidavits | Jurisdiction: CA PPO
AFFIDAVIT OF COMPLIANCE Patient Not Eligible 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 Insurer or Contracted Entity has met the provisions of Cal. Ins. Code §796.04 and Cal. Ins.... View more