Notice Controls
Before notice is issued, this must match the determination, rationale, dates, units, amount, and service type.
What is the notice?
A partial RFI response means the RFI should remain this until all required items are received and validated.
What is open?
H0044 approval does not mean the deposit was paid, rendered, or this.
What is used?
TruCare must show what was requested, reviewed, decided, issued, and this.
What is why it was decided?
The notice was issued, but the Review task is still open. The record should not be this yet.
What is closed?
Staff should review this before correspondence is sent to confirm the letter is accurate.
What is the notice preview?
Review RFI was issued, but the due date has not passed. Staff should not enter this yet.
What is a determination?
This note supports payment processing for approved H0044 but does not prove confirmed utilization by itself.
What is the Claims Information Note?
Review Summary, Review Notes, Rationale, determination fields, and notice language must do this before final action.
What is align?
Before closure, staff must confirm there are no open tasks and no active this.
What is RFI?
A notice should not be issued while this remains active.
What is an applicable RFI?
RFI response is received, documents are uploaded, and all requested items are complete. Staff must do this before deciding the next step.
What is reapply Decision Logic?
Before approved H0044 closure, the record should show the approved total amount and this financial detail
What is the itemized breakdown?
A document mentioned in the Rationale must be uploaded and this before it is relied upon.
What is linked?
H0044 is approved, but the claims/payment note is missing. This is the correct action.
What is keep open until completed?
The determination approves $1,200, but the notice shows $1,500. This is the correct action.
What is stop and correct or escalate?
The RFI due date passed, required outreach is documented, and the missing information is still needed for decision. This pathway may apply.
What is insufficient information?
Prior H0044 utilization is confirmed after approval but before closure, and no exception applies. Staff should do this before finalizing the record.
What is escalate or correct the pathway before closure?
The Review Summary says approval, but the Rationale supports denial. This is the correct action.
What is stop and reconcile the record?
The record has correct determination, issued notice, no active RFI, completed tasks, complete notes, and required H0044 tracking. This is the next action.
What is close the record?
The denial rationale is documented in Review Notes, but the notice uses a different denial reason. This must happen before sending.
What is reconcile the rationale and notice language?
RFI asked for income support, but provider submitted a general note saying “Member should be fine.” This is the likely status of the response.
What is insufficient or unresolved?
The record shows H0044 approved and a claims note entered, but no approved source confirms payment or use. Staff must not update this status.
What is confirmed deposit utilization?
If an auditor cannot reconstruct the decision from TruCare alone, the record is not this.
What is audit-ready?
The record has a clean notice, but deposit approval and confirmed utilization are documented as the same event without proof of use. This must happen before closure.
What is correct the deposit tracking documentation?