Your health plan is dedicated to reducing healthcare costs. The Rawlings Group is a trusted business partner of your health plan and has been asked to review paid medical claims information and determine if another party may be responsible for the resulting medical treatments. Your medical claims include certain treatment billing codes that are often related to an accident or injury. This may include events such as an accident involving a moving vehicle, a slip and fall, injury on the job, medical malpractice, or a defective product.
No. The provider listed in the letter you received could be someone other than your physician. For example, this person could be an emergency room physician or radiologist who cared for you during your Date of Treatment period listed on the letter.
Yes. Confirming that your treatment was not related to an accident is important information for your health plan to know.
Rawlings will continue to attempt to contact you as your health plan expects members to cooperate in resolving these questions. Depending upon the plan you have, your health plan may pend claims until these questions are resolved.
Your health plan has contracted with The Rawlings Group to review medical claims that they have already paid to identify situations where another party may be responsible to pay those claims. By contract, The Rawlings Group is authorized to perform this service for the health plan, and complies with all legal requirements (HIPAA) and your health plan´s requirements for handling your protected health information.
Please call the toll-free number listed on the questionnaire that was mailed to you. A representative dedicated to your insurance carrier will be available Monday through Friday between 8:00AM and 8:00PM EST.
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-815-2547 (TTY: 711).
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-844-897-4243 (TTY: 711).
ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-844-815-2548 (ATS: 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-844-897-4244 (TTY: 711).
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-844-897-4241 (TTY: 711).
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-844-897-4245 (телетайп: 711).
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-844-897-4242 (TTY: 711).
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-844-897-4246 (TTY: 711).
注意 : 如果您使用繁體中文，您可以免費獲得語言援助服務。 請致電 1-844-897-4247（TTY: 711）。
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-844-897-4248 (TTY: 711).
ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-877-720-9325 (መስማት ለተሳናቸው: 711).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-897-4249 (TTY: 711).
PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Awagan ti 1-877-720-9326 (TTY: 711).
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-877-720-9330 رقم هاتف الصم والبكم :711 ).
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-240-9854 (TTY: 711)번으로 전화해 주십시오.
توجه: اگر به زبان فارسی گفتگو می کنید٬ تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. با (TTY: 711) 1-877-720-9331تماس بگیرید
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-877-720-9327 (TTY: 711).
The Rawlings Group has served health plans across the nation since 1985, and we are a trusted business partner of your health plan. We review health care claims to ensure that the correct insurer or entity pays those claims according to the terms of the health plan as well as applicable state and federal laws. We provide all of our services by treating others with respect, integrity, and compassion, and we look forward to working with you.
Effective Date: October 24, 2023
How does The Rawlings Group gather my information through this Site(s)?
We gather information on this Site(s) in three ways. One way is when you send us your information directly, such as by completing an online questionnaire. Another way is by using technology to collect information regarding your use of the Site(s). Finally, if you choose to make payment by credit card, information is collected to ensure your payments are accurately applied to your account according to your instructions.
What information does The Rawlings Group collect through this Site(s)?
Generally, we collect both personally identifiable information ("PII") and non-personally identifiable information ("Non-PII"). PII refers to information that identifies you directly, such as your name, business affiliation, postal address, telephone number, and e-mail address. We collect PII through this web site(s) only when you voluntarily provide it to us. Non-PII refers to information that does not identify you personally, which we use to track use of our website. For instance, we may collect information about your computer's IP address, what type of web browser you use, and what pages of the Site(s) you visit to understand how the Site(s) is being used. See the "What are ‘cookies‘ and how does The Rawlings Group use them?" section below for more information.
What are “cookies” and how does The Rawlings Group use them?
What information does the Rawlings Group have about me beyond that information provided through its Site(s)?
Our health plan clients provide us Personally Identifiable Health Information about their health plan members securely, in compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), so we can determine whether claims they covered were paid correctly and by the correct party. We also obtain information from commercially available sources of claims, demographic and similar information. We do this to make sure the correct insurance carrier covers medical claims and to make sure we have the correct addresses and identifying information for people we need to contact to do our work.
In the course of performing our services for health plans we may receive additional information from third parties including but not limited to attorneys, medical providers, courts, state and federal agencies, and insurance companies and insurance services offices.
How does The Rawlings Group use and disclose my information?
To the extent we determine it is necessary in order to provide our services, and as permitted by HIPAA or other applicable law, we may use and disclose the information we receive to your health plan, to third parties, including, but not limited to, our service partners who provide information security, and legal service provider to us or to you, to other insurers, and to other parties when we are legally or contractually required to disclose your information. We and our service partners use your Personally Identifiable Information to operate our site(s) and to deliver their services. For example, our online payment transaction service provider must release your credit card information to the card-issuing bank to confirm payment on your account; release your payment information to the health plan that you paid through our site. We may also use your information for our own internal purposes and, where appropriate, to contact you directly. Our employees’ access to information is restricted to those who need to know the information for business purposes.
By submitting a telephone number to The Rawlings Group, you agree that a representative of The Rawlings Group may contact you at any number you provide, including a mobile phone number.
We may be required by law enforcement or judicial authorities to provide Personally Identifiable Information to the appropriate governmental authorities. We may disclose Personally Identifiable Information upon receipt of a court order, subpoena, or to cooperate with a law enforcement investigation. We fully cooperate with law enforcement agencies in identifying those who use our services for illegal activities. We reserve the right to report to law enforcement agencies any activities that we in good faith believe may be unlawful.
How does The Rawlings Group safeguard my information?
Rawlings is a HIPAA Business Associate of its client health plans. In compliance with HIPAA Rawlings has developed systems, procedures and training to protect the personal information that is entrusted to us.
We have implemented appropriate safeguards to protect your information from improper access, use and disclosure. First, we use a secure operating environment to protect information we receive. We limit access to your information to only those employees with a business need to do so. Finally, we take care to dispose of information securely so that third parties will not be able to access it. While we are committed to protecting your privacy, please be aware that no transaction over the Internet can be completely secure, and transmission of data online is therefore entirely at your own risk.
NOTICE TO CHILDREN UNDER THE AGE OF 18 AND THEIR PARENTS OR LEGAL GUARDIANS
OUR SITE IS INTENDED FOR ADULTS. WE DO NOT KNOWINGLY OR INTENTIONALLY COLLECT PERSONAL INFORMATION FROM ANYONE UNDER THE AGE OF 18. IF YOU ARE UNDER THE AGE OF 18, PLEASE DO NOT SEND THE RAWLINGS GROUP ANY PERSONAL INFORMATION THROUGH THIS WEB SITE(s). IF YOU KNOW OF ANYONE UNDER THE AGE OF 18 WHO HAS PROVIDED US WITH INFORMATION THROUGH THIS WEB SITE(s), PLEASE CONTACT US IMMEDIATELY at [email protected].
NOTICE TO CONNECTICUT RESIDENTS
Pursuant to Connecticut Public Act No. 08-167, this Privacy Protection Policy outlines the additional security measures we use in regards to our collection, storage, and disposal of Social Security numbers. We regularly review our physical, electronic, and procedural safeguards to ensure they effectively protect the confidentiality of Social Security numbers. We limit access to Social Security numbers to only those persons with a legitimate business purpose and prohibit the unlawful disclosure of Social Security numbers. We also provide appropriate training to our employees. Finally, we protect the confidentiality of Social Security numbers by using data encryption and secure data storage procedures and by destroying, erasing, or making unreadable Social Security numbers prior to disposal.
NOTICE TO CALIFORNIA RESIDENTS
The Rawlings Group serves as a Service Provider (as defined in the California Consumer Privacy Act) to a number of health plans. To the extent that you wish to exercise any rights you may have under the California Consumer Privacy Act, you may wish to contact your health plan directly.
The Rawlings Group complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. The Rawlings Group does not exclude people or treat them differently because of their race, color, national origin, age, disability or sex.
Free aids and services to people with disabilities so they may communicate effectively with us, such as:
Free language services to people whose primary language is not English, such as:
If you need these services, call 888-258-8060. TTY 711.
If you believe that The Rawlings Group has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: The Rawlings Group Compliance Officer, P.O. Box 2000, La Grange, KY, 40031-2000.
If you need help filing a grievance, The Rawlings Group Compliance Officer is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail, phone or fax at: U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F, HHH Building, Washington DC 20201, 800-368-1019, 800-537-7697 (TDD).
Complaint forms are available http://www.hhs.gov/ocr/office/file/index.html.