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iMVP claim and contention update scenarios

dianagriffin edited this page Mar 16, 2023 · 3 revisions

Scope

Single issue NEW and INCREASE hypertension claims

Updates handled by MAS

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

VRO scenarios that require updating the claim/contention

Happy path

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)

Offramp (for any reason)

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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