Terminology
What does the Ebens used for?
To show service connection of the disabilities
What happens during GP?
We are quality controlling files
What places must we notate commissions in order for them to be payable?
CRM, affiliate thread, commission thread, commission sheet and submit an invoice
During GP what is the affiliates role?
Helping the Veteran get any missing information
What document needs to be uploaded in order for it to go into CUE
RDL
What is the RDL used for?
What happens after GP?
Raters transcribe PAQs to DBQs the file goes into DBQs needed exp
Concerning expiring ITF dates what is the number of days we must notate them on the ITF expiring list?
120 days
After the file comes back from the doctor we must conduct a FQC (final quality control) Why?
Because the doctor might make changes to the DBQ depending on what they find on the exam
at 90 days or less
What is the ROI used for?
HIPPA compliant Veteran is allowing us to view their information
What happens after the Jrs make the DBQs
A senior rater will quality control their work
What doctor network do we prefer for expiring ITF dates and why?
Tpsych and because REE charges us fees
What two changes does the doctor make to the DBQ
Changes that affect the rating
Changes that DONT affect the rating
Two copies
our copy
doctors copy
What counts as sufficient medical records
Records that contain VA Notes (Encounters) or radiology
What happens at Network Selection
We are choosing a doctor network
Who has to cover any ITF fees before they get seen for the doctor?
The Veteran or the affiliate company will NOT cover those fees
If a Veteran is denied what status does it go into next
CUE
At what stage in the workflow do we ask the Veteran for a deposit
At the very beginning before GP
How many PAQs do we need?
Bonus question: What are some disabilities that might have more then one PAQ?
One per disability
Diabetes, Scars, nerves
It is sent to accounting for invoicing
What is the game plan used for?
To see what disabilities we can increase to get the client an overall rating
What happens during CUE?
A higher level rater will take a look at it and determine what can be done
What is the criteria for 100% Mental
Total occupational and social impairment