RFI or Not?
A required Housing Crisis Plan is missing from an HTS request.
RFI
Missing correctable documentation usually supports an RFI pathway. The provider can submit information that allows review to continue.
Which RFI is better?
A. "Need documents."
B. "Please submit the Housing Crisis Plan supporting the HTS request."
Response: B
A strong RFI specifically identifies what is needed.
What is the standard HSS authorization timeframe?
48 hours (2 business days)
Staff must understand the standard timeline before managing RFIs.
HTS request contains a PAR, UHAT, and HSP. What common required document might still be missing?
Housing Crisis Plan
Missing required support documents often trigger an RFI.
What must happen to new documents received through an RFI?
Upload and link them in TruCare.
If you rely on it, it belongs in TruCare.
The Member was not eligible on the PAR receipt date.
Not an RFI
Additional documentation cannot change eligibility on the PAR receipt date. Follow the denial or escalation pathway as applicable.
What is the first thing a strong RFI should identify?
What is missing
Tell the provider exactly what document or clarification is needed.
Can you finalize a determination while an RFI is active?
No
An active RFI is a hard stop for final determination.
A lease shows a $1,500 deposit, but the PAR shows $2,000.
Request clarification of the correct amount.
Ask for resolution of the conflict, not the whole file again.
What is the first approved missing information letter?
PA Missing Info 1st Attempt_NV
Use the approved RFI correspondence template.
The PAR requests HTS, but the documentation describes housing sustainment needs.
RFI
Conflicting documentation should be clarified before determination. The service story must match.
What should happen after an RFI is issued?
Pause determination while the RFI remains active.
An active RFI means the review is not ready for final determination.
What should be done when an RFI response arrives?
Review, upload, link, document, and reapply Decision Logic.
Receiving documents is not the end of the process.
The Housing Support Plan and PAR describe different services.
Request clarification (RFI)
Complete documentation still needs to tell one story.
What notice may also be required when an RFI is issued?
PA Notice of Std Auth Timeframe Ext_NV
The extension process requires the approved extension notice.
Documentation is blurry and unreadable.
RFI
The provider can correct this issue by supplying readable documentation.
True or False: "Send more information" is a good RFI.
False
The provider should not have to guess what you need.
Does a partial response automatically satisfy an RFI?
No
Staff must determine whether the missing issue was actually resolved.
The provider submitted a lease but not the documentation that resolves the deposit conflict.
Would you consider this satisfied or a partial response?
Partial response
Document what was received and what remains missing.
Can a determination be supported with documents that are uploaded but not linked?
No
Uploaded but unlinked documents are treated as not reviewed.
You are curious whether the Member has a second risk stratification completed.
Do not issue an RFI.
An RFI should only request information that is necessary to support the determination. Curiosity is not a reason to issue an RFI. Ask whether the information would actually change the review outcome. If not, do not request it.
What should every strong RFI explain besides what is missing?
Why it is needed
Connect the request to the review requirement.
Can a second RFI sometimes be appropriate?
Yes
When allowed and necessary, a second RFI may be used after a partial response.
The requested information would not change the determination.
Do not issue an RFI.
RFIs should never be used to delay a decision.
Finish the sentence:
"The best RFIs are not longer. They are ______."
Clearer
A great RFI removes confusion and helps the provider respond correctly the first time.