Healthsun Medicare Appeals

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Determinations, Grievances, and Appeals - HealthSun

(3 days ago) For more information, please see Chapter 9 in your plan’s Evidence of Coverage (EOC). An appeal to review and change a coverage decision we have made on your medical care or prescription drug coverage. You can call a HealthSun Member Service Representative or you can send your appeal in writing to our main … See more

https://healthsun.com/for-members/appeals-grievances/

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Health Sun HEALTH PLANS 9250 W. Flagler st. Suite # 600, FL …

(3 days ago) WebEmail: Grievances&[email protected] Please submit this appeal form with the required documentation electronically or by mail to the information below: HealthSun …

https://healthsun.com/wp-content/uploads/2021/09/provider-appealdispute-form-01072021plus.pdf

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Provider Claims Dispute Form - HealthSun

(8 days ago) WebPlease return completed form with all relevant supporting documentation to: HealthSun Health Plans, Audit & Recovery Department, Disputes Unit at 9250 W. Flagler Street, …

https://healthsun.com/wp-content/uploads/2021/09/Provider-Dispute-Letter_Rev-09.2021.pdf

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How do I file an appeal? Medicare

(3 days ago) WebAppeals in a Medicare health plan. If you have a Medicare health plan, start the appeal process through your plan. Follow the directions in the plan's initial denial notice and plan …

https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal

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Claims & appeals Medicare

(9 days ago) WebCheck your claim status with your secure Medicare account, your Medicare Summary Notice (MSN), your Explanation of Benefits (EOB), Medicare's Blue Button, or contact …

https://www.medicare.gov/claims-appeals

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Medicare health plan appeals - Level 1: Reconsideration

(7 days ago) WebIf you disagree with the initial decision from your plan (also known as the organization determination), you or your representative can ask for a reconsideration (a second look or review). You must ask for a …

https://www.medicare.gov/claims-appeals/file-an-appeal/medicare-health-plan-appeals-level-1-reconsideration

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IMPORTANT INFORMATION - HealthSun Health Plans

(4 days ago) Web877-206-0500. Fax. 305-234-9275. HealthSun Health Plans. 9250 West Flagler St. Suite 600. Miami, FL 33174. HealthSun Health Plans is a South Florida …

https://provider.healthsun.com/Home/ProviderCompliance

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Former HealthSun exec accused of Medicare fraud resulting in $53 …

(6 days ago) WebA former executive of Florida health insurance company HealthSun Health Plans Inc, which offers privately managed but publicly funded Medicare Advantage …

https://www.reuters.com/legal/government/former-healthsun-exec-accused-medicare-fraud-resulting-53-mln-overpayment-2023-10-26/

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HealthSun Health Plans, Inc. Medicare Advantage Plans with Part …

(6 days ago) WebThe Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal. Availability of benefits and …

https://health.usnews.com/medicare/healthsun-health-plans-inc-medicare-plans

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HealthSun Health Plans, Inc. Medicare Advantage Plans US News

(8 days ago) WebHealthSun Health Plans, Inc. Medicare Advantage plans without Part D (prescription drug) coverage.

https://health.usnews.com/medicare/healthsun-health-plans-inc-medicare-advantage-plans-without-drug-coverage

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Member Portal LogIn - HealthSun

(5 days ago) WebCall HealthSun Health Plans at 1-877-336-2069 (TTY 1-877-206-0500). Our hours of operation are Monday through Friday, 8am to 8pm. During October through …

https://memberportal.healthsun.com/

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HealthSun Avoids Charges By Self-Disclosing $53M Scam

(2 days ago) WebLaw360 (October 26, 2023, 6:05 PM EDT) -- A former executive for a Florida health care plan has been indicted for an alleged $53 million Medicare fraud scheme, while the …

https://www.law360.com/articles/1737300/healthsun-avoids-charges-by-self-disclosing-53m-scam

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DOJ Declines Prosecution of HealthSun After Company - Policy …

(8 days ago) WebThe significant improvements to the compliance program by HealthSun include significant investments in designing, implementing, and testing a risk-based and …

https://www.policymed.com/2024/02/doj-declines-prosecution-of-healthsun-after-company-uses-voluntary-self-disclosure-policy.html

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2024 Medicare Advantage Plan Benefit Details for the HealthSun …

(2 days ago) WebHealthSun HealthAdvantage Plan (HMO) Location: Miami-Dade, Florida Click to see other locations. Plan ID: H5431 - 001 - 0 Click to see other plans. Member Services: 1-877-336 …

https://q1medicare.com/MedicareAdvantage-PartC-MedicareHealthPlanBenefits.php?state=FL&ZIP=&countyCode=12086&contractId=H5431&planId=001&segmentId=0&plan=HealthSun%20SunPlus%20Advantage%20Plan%20(HMO)%20-%20H5431-001-0

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2024 HealthSun HealthAdvantage Plan (HMO) in Broward, Florida

(9 days ago) WebThe HealthSun HealthAdvantage Plan (HMO)’s formulary is divided into 6 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing …

https://q1medicare.com/MedicareAdvantage-HealthPlansMAPDBenefitsPlainText.php?state=FL&countyCode=12011&contractId=H5431&planId=012&segmentId=0&plan=HealthSun%20HealthAdvantage%20Plan%20(HMO)%20-%20H5431-012-0

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Mental Health & Substance Use Disorders Medicare

(Just Now) WebMedicare covers certain screenings, services, and programs that aid in the treatment and recovery of mental health and substance use disorders. If you or someone you know is …

https://www.medicare.gov/coverage/mental-health-substance-use-disorder

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Appeals court rejects city’s bid to switch municipal retirees to

(8 days ago) WebA state appeals court upheld a previous ruling barring New York City from transferring 250,000 municipal retirees to Medicare Advantage plans, marking another …

https://www.crainsnewyork.com/health-pulse/appeals-court-rejects-new-york-citys-bid-switch-municipal-retirees-medicare-advantage

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Former Health Plan Risk Adjustment Director Indicted for Fraud …

(3 days ago) WebIn 2017, Anthem purchased the south Florida network HealthSun, which offered Medicare Advantage Plans to beneficiaries. CMS Medicare pays Medicare …

https://www.workerscompensation.com/daily-headlines/former-health-plan-risk-adjustment-director-indicted-for-fraud-charges/

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“Discharge” from a Skilled Nursing Facility: What Does it Mean and …

(6 days ago) WebThe expedited appeals process is intended to keep Medicare-covered services continuing, without interruption. The standard appeals process serves a similar …

https://medicareadvocacy.org/discharge-from-a-skilled-nursing-facility-what-does-it-mean-and-what-rights-does-a-resident-have/

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Medi-Cal & Medicare for People with Disabilities

(Just Now) WebMedi-Cal, the Medicaid program in California, provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. Medi-Cal can …

https://cahealthadvocates.org/disabilities/medi-cal-medicare-for-people-with-disabilities/

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How to file an EMTALA complaint CMS - Centers for Medicare

(4 days ago) WebTo file a complaint. There are 2 ways to file a complaint about a possible EMTALA violation: Contact the State Survey Agency in the state where the hospital is …

https://www.cms.gov/priorities/your-patient-rights/emergency-room-rights/how-to-file-complaint

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Adams administration to bring Medicare Advantage push before …

(1 days ago) WebMayor Adams’ legal team is set to ask New York’s highest court to clear the way for his administration’s push to enroll some 250,000 retired city workers in a controversial …

https://www.msn.com/en-us/news/us/adams-administration-to-bring-medicare-advantage-push-before-ny-s-top-court/ar-BB1mO61O

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