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iMVP claim and contention update scenarios
dianagriffin edited this page Mar 16, 2023
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3 revisions
Single issue NEW and INCREASE hypertension claims
Before VRO is notified of an automation eligible claim, MAS makes the following automation-specific updates to the claim/contention:
Claim:
- Temporary Station of Jurisdiction = 398
Contention:
- Special Issue = Rating Decision Review - Level 1 (RDR1)
- Special Issue = RRD
- Automation Indicator = False
In order for an automated claim to be routed and tracked appropriately after processing has completed in VRO, the claim/contention needs to be updated:
| Field (object) | Temporary Station of Jurisdiction (claim) | Lifecycle Status (claim) | Automation Indicator (contention) | Lifecycle Status (contention) | Special Issues (contention) |
|---|---|---|---|---|---|
| Field value when claim is RFD | 398 | RFD | True | RFD | RRD (remove RDR1) |
| Field value when exam is ordered | 398 | Open | True | Open | RRD (remove RDR1) |
In order for an automation eligible claim to be processed manually when offramped by VRO, updates made to the claim/contention as part of automation processing need to be reverted:
| Field (object) | Temporary Station of Jurisdiction (claim) | Lifecycle Status (claim) | Automation Indicator (contention) | Lifecycle Status (contention) | Special Issues (contention) |
|---|---|---|---|---|---|
| Field value for any offramped claim | 398 | Open | False | Open | Do NOT include Rating Decision Review - Level 1 (RDR1) or RRD
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