ADIVSORY NOTICES
APL 24-012 – Single Point of Contact for Hospitals to Request Authorization for Poststabilization Care
FROM THE OFFICE OF THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE: ALL PLAN LETTER DATE: June 25, 2024 TO: All Full-Service Health Care Service Plans1 FROM: Sarah Ream, Chief Counsel…
Published on July 2, 2024
ADIVSORY NOTICES
ADVISORY NOTICE: AUTHORIZATION REQUESTS FOR POST-STABILIZATION CARE
Dear Provider Members, Our office has been actively pursuing the resolution of claims on your behalf for post-stabilization care and services that we believe have been improperly denied by health…
Published on July 2, 2024
LETTERS & STATEMENTS
Letter to the OIG on “Non-Interference” Policy
Esteemed Provider Members, Here at ERN/TRAF, we advocate every day for you, your providers, and patients. Our advocacy takes many forms, but we approach each case with a desire to…
Published on January 31, 2024
DMHC UPDATES
DHMC Advises Requirements for Requesting Authorization for Post-Stabilization Care
Dear Provider Members, Our office has been actively pursuing the resolution of claims on your behalf for post-stabilization care we believe have been improperly denied by health care plans. We…
Published on October 25, 2023
CASE STUDIES
Obtaining Authorization While Patient Is In House
MYTH: MA Plans are not required to respond to an inpatient authorization request. FACT: MA Plans ARE required to respond to an inpatient authorization request. A large 11 hospital provider member recently submitted a…
Published on June 29, 2022
CASE STUDIES
Community Rallies Around Yorba Linda Teen in Need of Operation
ERN in the news! This morning, I saw this piece aired by Channel 5 of a young boy we successfully represented against the State of California (several years) ago and…
Published on April 6, 2019