CA HMO Script – Maternity Coverage (FREE DEMO)
Last Updated: August 30, 2020 | Jurisdiction: CA HMO
ASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility? Did the plan deny maternity coverage for no authorization? Is the plan refusing to comply with Health and Safety Code §1367.62(a)? The objective is to bring the plan into compliance with state law designed to... View more
CA HMO Script – Untimely Payment (FREE DEMO)
Last Updated: August 30, 2020 | Jurisdiction: CA HMO
ASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from the payor? IF SO, WHEN; HOW LONG AFTER THE CLAIM WAS BILLED? How many days is the plan in violation of the above prompt pay statute? Did they underpay the claim LATE, without the required... View more
CA PPO Script – Maternity Coverage (FREE DEMO)
Last Updated: August 30, 2020 | Jurisdiction: CA PPO
ASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility? Did the plan deny maternity coverage for no authorization? Is the plan refusing to comply with Ins. Code §10123.87(a)? The objective is to bring the plan into compliance with state law designed to benefit the... View more
CA PPO Script – Untimely Payment (FREE DEMO)
Last Updated: August 30, 2020 | Jurisdiction: CA PPO
ASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from the payor? IF SO, WHEN; HOW LONG AFTER THE CLAIM WAS BILLED? How many days is the plan in violation of the above prompt pay statute? Did they underpay the claim LATE, without the required... View more
ERISA Script – Untimely Payment (FREE DEMO)
Last Updated: November 20, 2021 | Jurisdiction: ERISA
ASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from the payor? IF SO, WHEN; HOW LONG AFTER THE CLAIM WAS BILLED? How many days is the plan in violation of the above prompt pay statute? Did they underpay the claim LATE, without the required... View more
MA Script – Maternity Coverage (FREE DEMO)
Last Updated: August 13, 2020 | Jurisdiction: MA
ASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility? Did the plan deny maternity coverage for no authorization? Is the plan refusing to comply with 45 CFR §146.130(a)? The objective is to bring the plan into compliance with federal law designed to benefit the... View more
MA Script – Non-urgent Authorization Timeframes (FREE DEMO)
Last Updated: November 21, 2021 | Jurisdiction: MA
ASK YOURSELF: What date was the request for non-urgent authorization made? Was there any written communication (request for information, denial, etc.) from the payor? If so, how long after the request was made did you receive any written communication? How many days is the plan in violation of the statutory authorization timeframe under 42 CFR... View more
MA Script – Untimely Payment (FREE DEMO)
Last Updated: November 20, 2021 | Jurisdiction: MA
ASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from the payor? IF SO, WHEN; HOW LONG AFTER THE CLAIM WAS BILLED? How many days is the plan in violation of the above prompt pay statute? Did they underpay the claim LATE, without the required... View more
AL HMO Script – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Jurisdiction: AL HMO
ASK YOURSELF: What date was the claim initially billed? What date was the claim paid? Did the plan pay this claim LATE without the required statutory interest? How many days is the plan in violation of the prompt payment statute (Ala. Code §27-1-17(a))? The staff will be tactful and professional in communicating with the payer... View more
AL HMO Script – Maternity Coverage
Last Updated: October 7, 2021 | Jurisdiction: AL HMO
ASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility? Did the plan deny maternity coverage for no authorization? Is the plan refusing to comply with Ala. Code §27-48-2? The objective is to bring the plan into compliance with state law designed to benefit the... View more