***DOCUMENT ATTACHED [redacted] Regarding compliant [redacted] for member [redacted] After review of the member records wehave identified two claims ( [redacted] ) that required reprocessing and havesubmitted those claims to be adjusted and paidIt was also verified that there was no gap in coverage duringthe 1/1/to 8/31/date for [redacted] member ID [redacted] .In addition to faxing these documents to the number on your letter [redacted] I have also mailed them to:Revdex.com PO Box 1OOO DuPont,WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution
RE; ID [redacted] Dear Ms***, We received your letter dated July 21stThis was in reference to customer [redacted] request to add two providers to our networkOur credentialing process was initiated for [redacted] on 3/and 2/for [redacted] I have escalated the resolution for both providersBoth should complete within the next daysCredentialing normally takes up to In addition we have reviewed the member's request for a reprocessing of the two claims currently on file for Dr [redacted] Claim# [redacted] and [redacted] We have requested that both be reprocessedThis can only occur once credentialing and contracting are completeThis process can take up to days and the member with receive new EOBsIn addition to faxing these documents to the number on your letter 206-431-, I have also mailed them to: Revdex.com POBox DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution
Complaint: ***I am rejecting this response because: They failed to resolve the problem by the end of the week as promised, and they did not answer my phone call near the end of the business day that Friday, nor have they returned my call by the following Monday afternoonOne of my medical bills fell past due on Saturday.Sincerely,*** ***
Dear Ms* ***
Regarding compliant *** for member *** ***We have been in contact with and worked toresolve to the members satisfaction her concerns and billing payment set upThe member has set uprecurring payments and been in communication with our customer service supervisor and
reports that allissues have been resolved
In addition to faxing these documents to the number on your letter***I have also mailed them to:Revdex.comPO Box 1000DuPont, WA
Please feel free to reach out to me directly on this matter to assure a timely resolution.Sincerely,Jeff M***Director of Member Experience*** **
Dear Ms***, We received your letter dated August 26thThis was in reference to customer *** *** regarding the reprocessing of claim ***This claim has been reprocessed as of 8/24/and I have spoken directly with the member about the resolution 8/12/and provided follow up regarding escalation paths for future discussionsPlease close this case as resolvedIn addition to faxing these documents to the number on your letter ***I have also mailed them to: Revdex.com PO Box DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution*** Sincerely, Jeff M*** Director of Member Experience ***
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** ***
To: *** ***RE: ID ***
Dear Ms***,
In response to the customer complaint ID above it has been resolved with the member.We had contacted the member upon receipt of the letter and began working with him directly andjust closed out the issues with him last Friday 11/13/to his
satisfactionPlease update yourrecords to reflect that the case is closed
We identified five claims that due to coding reasons were paid incorrectly and those havebeen adjusted with the provider to accurately reflect the visits reasons.In addition to faxing these documents to the number on your letter206-431-I have also mailed them to;Revdex.comPO Box 1000DuPont, WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution.Sincerely,Jeff M***Director of Member EKperience*** ** *** ** *** *** *** *** *** *** *** *** *** *** *** *** *** ***
Regarding the complaint made by the provider about nonpayment of claims submittedWe havebeen working with the provider for several months to address her payments requestsThe claims in questionwere submitted by Ms*** outside of a Supervising entity and her current status as a registered
internis equivalent to an unlicensed providerThis violates our policy of not covering services performed by anunlicensed providerWe have informed her via letter and phone that she may be able to submit claims undera Supervising entity or ClinicianIn addition we have requested that payments made In error be returned tothe CO-OP
Due to the nature of this case it has taken time to Investigate, review and respondWe value ourprovider community and seek to reach resolution as quickly as possibleI ask that you moved this complaint to your closed files
Sincerely,Jeff M***Director of Member Experience503-388-
RE; ID *** Dear Ms***, We received your letter dated July 21stThis was in reference to customer *** *** request to add two providers to our networkOur credentialing process was initiated for *** *** on 3/and 2/for *** ***I have escalated the resolution
for both providersBoth should complete within the next daysCredentialing normally takes up to In addition we have reviewed the member's request for a reprocessing of the two claims currently on file for Dr***Claim# *** and ***We have requested that both be reprocessedThis can only occur once credentialing and contracting are completeThis process can take up to days and the member with receive new EOBsIn addition to faxing these documents to the number on your letter 206-431-, I have also mailed them to:
Revdex.com POBox DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution
To:
RE: ID ***
Dear Ms***
Regarding the complaint made by our member *** ***I had already been in contact with Mr.*** related to his request for termlnatlonln cases where the member has an on exchange planstermination requests must go to healthcare.gov in order to be
processedour customer servicerepresentatives provided that information to Mr*** and I have confirmed that we have received anupdated file on 3/18/from healthcare.gov and his account has been terminated back to 11/30/andany owed premiums will be refunded
In addition to faxing these documents to the number on your letter*** I have also mailed them to:Revdex.comPO Box 1000DuPont, WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution
Sincerely,Jeff M***
RE: lD *** Dear Ms***, I received your letter dated June 8th. This was in reference to the submitted complaint from May 1st I have reviewed the members account and taken the following actionsThe member was contacted directly about setting up credit monitoring through ID
experts on 6/9/15, a service offered to all members potentially impacted by the recent security incidentIn addition we have reviewed the member's request for a full refund of premiums and regret that he experienced a less than satisfactory customer experienceHowever, health care coverage was provided for the time period the member was active with the Oregon's Health and as such we will not issue a credit for the member's premiumWhile we have offered credit protection to members there is no evidence that the member's information has been compromised or his credit damagedIn fact the services provided allow the member to assure that his credit is protectedAs requested we have expedited setting up credit monitoring and terminated the members account as of 4/6/In addition to faxing these documents to the number on your more recent letter ***I have also mailed them to:
Revdex.com PO Box
DuPont, WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution*** Sincerely,
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** ***
Revdex.com:I accept the response, however, we expect Oregon’s Health to be true to their word and NOT run us around again and say there is a gap in our coverageWe also expect timely processing of ALL unprocessed and unpaid claims and for Oregon’s Health to pay their share of ALL expenses and to see to it that we are reimbursed for ALL the claims we paid more than our share of
***DOCUMENT ATTACHED***
Regarding compliant *** for member *** *** ***After review of the member records wehave identified two claims (***) that required reprocessing and havesubmitted those claims to be adjusted and paidIt was also verified that
there was no gap in coverage duringthe 1/1/to 8/31/date for *** *** *** member ID ***.In addition to faxing these documents to the number on your letter ***I have also mailed them to:Revdex.com PO Box 1OOO DuPont,WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution
RE: ID *** Dear Ms***, We received your letter dated July 30thThis was in reference to customer *** ** *** regarding the reprocessing of claim *** ***Resolution of the request has been escalated and will be resolved before the end of this weekOnce it is finalized a supervisor
in our customer service call center will be contacting the memberIn addition we have communicated directly with the member about the escalation and provided follow up regarding escalation paths for future discussionsIn addition to faxing these documents to the number on your letter *** *** * I have also mailed them to: Revdex.com PO Box DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution*** Sincerely, Jeff M*** Director of Member Experience ***
***DOCUMENT ATTACHED [redacted] Regarding compliant [redacted] for member [redacted] After review of the member records wehave identified two claims ( [redacted] ) that required reprocessing and havesubmitted those claims to be adjusted and paidIt was also verified that there was no gap in coverage duringthe 1/1/to 8/31/date for [redacted] member ID [redacted] .In addition to faxing these documents to the number on your letter [redacted] I have also mailed them to:Revdex.com PO Box 1OOO DuPont,WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution
RE; ID [redacted] Dear Ms***, We received your letter dated July 21stThis was in reference to customer [redacted] request to add two providers to our networkOur credentialing process was initiated for [redacted] on 3/and 2/for [redacted] I have escalated the resolution for both providersBoth should complete within the next daysCredentialing normally takes up to In addition we have reviewed the member's request for a reprocessing of the two claims currently on file for Dr [redacted] Claim# [redacted] and [redacted] We have requested that both be reprocessedThis can only occur once credentialing and contracting are completeThis process can take up to days and the member with receive new EOBsIn addition to faxing these documents to the number on your letter 206-431-, I have also mailed them to: Revdex.com POBox DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution
Complaint: ***I am rejecting this response because: They failed to resolve the problem by the end of the week as promised, and they did not answer my phone call near the end of the business day that Friday, nor have they returned my call by the following Monday afternoonOne of my medical bills fell past due on Saturday.Sincerely,*** ***
Dear Ms* ***
Regarding compliant *** for member *** ***We have been in contact with and worked toresolve to the members satisfaction her concerns and billing payment set upThe member has set uprecurring payments and been in communication with our customer service supervisor and
reports that allissues have been resolved
In addition to faxing these documents to the number on your letter***I have also mailed them to:Revdex.comPO Box 1000DuPont, WA
Please feel free to reach out to me directly on this matter to assure a timely resolution.Sincerely,Jeff M***Director of Member Experience*** **
Dear Ms***, We received your letter dated August 26thThis was in reference to customer *** *** regarding the reprocessing of claim ***This claim has been reprocessed as of 8/24/and I have spoken directly with the member about the resolution 8/12/and provided follow up regarding escalation paths for future discussionsPlease close this case as resolvedIn addition to faxing these documents to the number on your letter ***I have also mailed them to: Revdex.com PO Box DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution*** Sincerely, Jeff M*** Director of Member Experience ***
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** ***
To: *** ***RE: ID ***
Dear Ms***,
In response to the customer complaint ID above it has been resolved with the member.We had contacted the member upon receipt of the letter and began working with him directly andjust closed out the issues with him last Friday 11/13/to his
satisfactionPlease update yourrecords to reflect that the case is closed
We identified five claims that due to coding reasons were paid incorrectly and those havebeen adjusted with the provider to accurately reflect the visits reasons.In addition to faxing these documents to the number on your letter206-431-I have also mailed them to;Revdex.comPO Box 1000DuPont, WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution.Sincerely,Jeff M***Director of Member EKperience*** ** *** ** *** *** *** *** *** *** *** *** *** *** *** *** *** ***
Regarding the complaint made by the provider about nonpayment of claims submittedWe havebeen working with the provider for several months to address her payments requestsThe claims in questionwere submitted by Ms*** outside of a Supervising entity and her current status as a registered
internis equivalent to an unlicensed providerThis violates our policy of not covering services performed by anunlicensed providerWe have informed her via letter and phone that she may be able to submit claims undera Supervising entity or ClinicianIn addition we have requested that payments made In error be returned tothe CO-OP
Due to the nature of this case it has taken time to Investigate, review and respondWe value ourprovider community and seek to reach resolution as quickly as possibleI ask that you moved this complaint to your closed files
Sincerely,Jeff M***Director of Member Experience503-388-
RE; ID *** Dear Ms***, We received your letter dated July 21stThis was in reference to customer *** *** request to add two providers to our networkOur credentialing process was initiated for *** *** on 3/and 2/for *** ***I have escalated the resolution
for both providersBoth should complete within the next daysCredentialing normally takes up to In addition we have reviewed the member's request for a reprocessing of the two claims currently on file for Dr***Claim# *** and ***We have requested that both be reprocessedThis can only occur once credentialing and contracting are completeThis process can take up to days and the member with receive new EOBsIn addition to faxing these documents to the number on your letter 206-431-, I have also mailed them to:
Revdex.com POBox DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution
To:
RE: ID ***
Dear Ms***
Regarding the complaint made by our member *** ***I had already been in contact with Mr.*** related to his request for termlnatlonln cases where the member has an on exchange planstermination requests must go to healthcare.gov in order to be
processedour customer servicerepresentatives provided that information to Mr*** and I have confirmed that we have received anupdated file on 3/18/from healthcare.gov and his account has been terminated back to 11/30/andany owed premiums will be refunded
In addition to faxing these documents to the number on your letter*** I have also mailed them to:Revdex.comPO Box 1000DuPont, WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution
Sincerely,Jeff M***
RE: lD *** Dear Ms***, I received your letter dated June 8th. This was in reference to the submitted complaint from May 1st I have reviewed the members account and taken the following actionsThe member was contacted directly about setting up credit monitoring through ID
experts on 6/9/15, a service offered to all members potentially impacted by the recent security incidentIn addition we have reviewed the member's request for a full refund of premiums and regret that he experienced a less than satisfactory customer experienceHowever, health care coverage was provided for the time period the member was active with the Oregon's Health and as such we will not issue a credit for the member's premiumWhile we have offered credit protection to members there is no evidence that the member's information has been compromised or his credit damagedIn fact the services provided allow the member to assure that his credit is protectedAs requested we have expedited setting up credit monitoring and terminated the members account as of 4/6/In addition to faxing these documents to the number on your more recent letter ***I have also mailed them to:
Revdex.com PO Box
DuPont, WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution*** Sincerely,
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** ***
Revdex.com:I accept the response, however, we expect Oregon’s Health to be true to their word and NOT run us around again and say there is a gap in our coverageWe also expect timely processing of ALL unprocessed and unpaid claims and for Oregon’s Health to pay their share of ALL expenses and to see to it that we are reimbursed for ALL the claims we paid more than our share of
***DOCUMENT ATTACHED***
Regarding compliant *** for member *** *** ***After review of the member records wehave identified two claims (***) that required reprocessing and havesubmitted those claims to be adjusted and paidIt was also verified that
there was no gap in coverage duringthe 1/1/to 8/31/date for *** *** *** member ID ***.In addition to faxing these documents to the number on your letter ***I have also mailed them to:Revdex.com PO Box 1OOO DuPont,WA 98327Please feel free to reach out to me directly on this matter to assure a timely resolution
RE: ID *** Dear Ms***, We received your letter dated July 30thThis was in reference to customer *** ** *** regarding the reprocessing of claim *** ***Resolution of the request has been escalated and will be resolved before the end of this weekOnce it is finalized a supervisor
in our customer service call center will be contacting the memberIn addition we have communicated directly with the member about the escalation and provided follow up regarding escalation paths for future discussionsIn addition to faxing these documents to the number on your letter *** *** * I have also mailed them to: Revdex.com PO Box DuPont, WA Please feel free to reach out to me directly on this matter to assure a timely resolution*** Sincerely, Jeff M*** Director of Member Experience ***