Delays
The delay letter sent when we need the hospital records to help rule out DWI, and there is no Police Report available
What is "ER RECS"
Denial for someone who is confirmed to be in the course of their employment?
What is "WCOMP"
Despite popular demand, there is not a blank version of this in STEM.. No matter how long you look for it.
Other expenses shall consist of all reasonable and necessary expenses incurred on account of injuries arising out of the use or operation of a motor vehicle. Your claim for reimbursement on date(s) of service, is denied as the service does not qualify as an 'other necessary and reasonable expenses' under New York State No-Fault Regulation 68A, 65-3.16(c).
What is "OELNONCOV"
True or False: You have 30 days to send in the No-Fault Application to your insurance carrier.
We're encouraged to verify vehicles in an accident by any possible means, before sending this letter, as a last resort.
What is "IV INVOLVEMENT"
Commonly used when the insured fails to attend 2 medical exams.
What is "NONCOOP IME-ALL"
What is "OELDETAIL"
Soy el Representante de Reclamaciones Médicas que manejará su reclamo recientemente reportado. Mi meta es hacer que su experiencia de reclamo médico sea tan simple como sea posible para usted.
A continuación encontrará la información de facturación de Progressive para tratamiento médico relacionado con este accidente.
Proporcione esto a los proveedores médicos para que puedan enviar las facturas directamente a nosotros. Si tiene gastos médicos de bolsillo o recibe facturas médicas por correo, por favor llámeme o envíeme por fax o por correo la información para que pueda contactar al proveedor y cuidarla por usted.
Para su conveniencia, puede acceder a su reclamo en Progressive.com. Podrá ver los pagos médicos realizados en su nombre en el sitio web y acceder a información adicional relacionada con su reclamo.
Envíe facturas médicas a:
What is "SPANISH 2 WEEK CONTACT-EFF"
OBEL will default after this many days once the second NF13 is sent.
What is "15 DAYS"
APIP is being used and we need the NF11, so we will send this delay
What is "NF11 DELAY"
This is the NYS Regulation term for any denial
What is "NF10"
The denial letter sent advising the amount of time the insured has to claim an OEL can be found in this letter
What is "OTHEREXPENSE1YEAR"
If our insured's at fault, and we have paid out anything in one of the optional line coverages, we will issue this letter, and maybe even delay. (+100 for the delay)
What is "NF11" / "NF11 DELAY"
There is no delay for this No-Fault form, asking the insured to elect how to use a specific line coverage
What is the NF13?
Delay used MOSTLY for OOS losses, where we need to verify someone's address.
What is "RESIDENCY DELAY"
Introduced back on 05/21/2021, this denial is used when we're presented with a reimbursement request, for any non-prescription medication/equipment/supplies
What is "OTC DENIAL"
Two members of the SAME household are claiming identical mileage, so we'll send this letter.
What is "TRANS"
Claim number:
Policy number:
Policy holder:
Date of loss:
Patient name/DOB:
Progressive bill number:
Date bill received:
Service date(s):
Billed amount:
What is "ITEMIZED BILL REQUEST"
After opening your new loss, you discover you have a FATALITY claim. Name one of the letters you may send (Extra 100 points if you can name more than 2)
What is
"CONDOLENCES-EFF"
"DEATH BENEFIT-EFF"
"MEDPAY"
"AUTOPSYAUTH"
Although the name may fool you, we use this letter to delay when we need to rule out Worker's Compensation
What is "NFAPP DELAY"
While there is no UDF in MDP for this denial, we will use this letter for policies that were cancelled before the date of loss
What is "TERM"
While this denial is overlooked, you may need to use it to deny this specific OEL if not relating to the accident
What is "EYEGLASSES"
STEM lists this letter as the denial for Exclusion "H1" however, your policy says otherwise.
What is "FELONY"
Explain the process the MCR will need to do when you receive a patient submitted "bill"
What is:
"Call the provider"
"Send Patient Bill Letter"
"Send NF3/NF4"