DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENTS StandardStandard OperatingOperating ProcedureProcedure
- Open the letter and copy their email address from SAP CRM/PACE into the template.
Complete the rest of the blanks in the letter by referencing the Testing Tool tab. The
return date for the RTP is a minimum of 14 days from the date of the letter (inclusive of
weekends).
- Once complete, save the letter to PDF and save to the RTP folder created under the 2.
Letters Folder (same naming convention as word version).
- Navigate to your Testing Tool and open the RTP – Claim Review tab. Highlight all claims
starting from row 1.
- To change to PDF click File, Print. Ensure you select and change the scaling to ‘Fit All
Columns on One Page’.
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Click Print then Create PDF/XPS Document
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Save to the RTP folder previously created under 2. Letters.
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Navigate to the Templates folder, then to the Request for Information Templates folder,
right click and download the SP – Request for Information email template and paste the
primary contact and/or Account Manager email address into the Good
morning/afternoon field.
- Ensure PaymentsIntegrityReview is selected in the From field.
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DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS Standard Operating Procedure
From “ s47E(d) - ce ain opera r–;-i I I
To I I 11. Attach the approved PDF RTP-Request for Information letter and the PDF Claims Review to the email. Proofread the email before hitting send. 12. Save a copy of the email in the RTP folder under 1. Emails by holding and dragging across from Sent, repeat this process dragging from the Sent Folder to Provider Folder in group mailbox. 13. Go to your Case Tracker and update the Case Status column select In Progress - Waiting for provider. Update the Support Provider - RFI column to reflect the date the Request for Information Letter was sent as well as the PMA Review Notice column to reflect notice letter being sent (if applicable). This will automate the Case Due Date column to reflect a minimum of 14 days from today’s date. 14. If you receive an email with documentation from the provider - refer to Evidence Received section.
Phase 2 - Monitor Payment Integrity inbox for response
- Your Team Leader will monitor the Payment Integrity Review inbox for all correspondence from the PMA and Support Provider and/or Participants and Nominees.
- If you receive an email, please action accordingly. Once you have actioned you will need to move both the received and sent emails into the Provider Folder located in the group mailbox.
If at any stage throughout the process you receive documentation from the provider such as an invoice or a receipt, your Team Leader will move these to the relevant provider folder within the group mailbox. Note: If the Participant, Provider or Plan Manager has responded to the notification or request for information, ensure you provide a response in a timely manner. Seek Team Leader assistance if you are unsure on how to respond.
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Phase 3 – Begin quality analysis process within the Testing tool s47E(d) - certain operations of agencies
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Phase 4 – QA Tracker with relevant links to information
- Navigate to 2. Letters folder within the RTP folder previously created and right click
on the relevant Outcome Notice document, open in app.
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Complete the blank fields in the letter.
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Navigate to 6. QA and Cancellation Tracker, right click and open in app.
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On the QA Log tab, enter the relevant data for Date, Case Number, Case Officer
Name, Support Provider ID, Support Provider Name, and Project Name.
- Copy the Testing Tool link and paste under column G under Testing Tool, copy the
Outcome Notice letter link and paste under column H under Finalisation Letter.
- Navigate to your Individual case tracker, filter for the relevant RTP number, update
the Case Status to ‘In Progress - Ready for QA claims review’.
Phase 5 – Send Invitation to Comment letter to the Legal Team and
Provider for all adverse decisions.
- Once QA is complete and Justifications have been updated, for all adverse decisions
you will need to draft an Invitation to comment letter.
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Please use the template located in the Templates folder.
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Reach out to your Team Leader or EL for related Tip Off information to include in your
draft letter – please do not summarise this yourself, paste in exact and Legal will work
with you to reword this information.
- Please highlight the tip off in yellow in your draft letter and add a comment asking for
assistance in re-wording.
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- Navigate to the outcome tab of your testing tool and update the outcome and reasons accordingly. s47E(d) - certain opera·ons of agencie
Testing tool RTP2556 - Claim Review RTP2556 - Outcome Data Validation I I
2
3 4 5 6
- Once you have completed the Outcome Tab you will need to change to PDF.
- Highlight from A 1 through to F1 and then down to the bottom of the listed claims
- To change to PDF click File, Print. Ensure you select and change the scaling to ‘Fit All Columns on One Page’ and Change document to Landscape Orientation.
Settings 2 PrintActiveSheets “’ i;t:±1 Only print the active sheets
Pages: I
1,2,3 1,2,3 1,2,3 l[IJ. Collated I 8 Port,ait Orientation
21 cm x 29.7 cm . A4 I□ fFfl Normal Ma1gins l:ld:I Top: 1.91 cm Bottom: 1.91 c.. , f“I NoScal ing -rod Print sheets at their actual size Page Setup
- Click Print then Create PDF/XPS Document
Create a PDF/XPS Document Create PDF/XPS Document B • Prdee layout,. fomutting, fontc;, and images • Content can’t be easily changed Change File Type • Free v1ewert are available on the web
Create. PDF/XPS
- Save to the relevant RTP folder. 11 . Once complete you will need to send both the draft letter and the Attachment A to the Team Leader for review.
- Once your Team Leader is satisfied with your letter they will forward to the EL for QA.
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- Once the EL has signed off you will need to send this through to the Legal Team along
with an Attachment A – this contains the preliminary decisions and justifications for
review.
- The Legal team will review both the letter and Attachment A to ensure decisions are
correct and articulated well. Comments will be placed on the letter and sent back once
complete.
- Once you receive feedback from the Legal team, please ensure you action all
comments and make the necessary changes.
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Once complete you will need to send this back to Legal for their second review.
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This process will go back and forth until Legal are satisfied with the letter and decisions
and will then give you the approval for the letter to be sent to the provider.
- Once you have sent the letter to the provider please update the status in the QA tracker
to state “PF Letter sent to Provider”
Phase 6 – Review of evidence
Release/Substantiated/Compliant s47E(d) - certain operations of agencies
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENTS StandardStandard OperatingOperating ProcedureProcedure s47E(d) - certain operations of agencies
Phase 7 – Send Outcome letter to the provider and move to completed
- Once QA process has been completed and payment has been actioned, the TL will
notify you that it is ok to proceed. Navigate to the previously created RTP folder and to
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Letters.
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Open and amend the Outcome Notice letter then save as PDF.
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Navigate to 3. Claims Review, open to the Testing tool, right click and open in app.
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On the RTP – Outcome tab, amend any outcomes needed as a result of the QA
process, then highlight all claims including the banner data in row 1 to print to PDF.
- To change to PDF click File, Print. Ensure you select and change the scaling to ‘Fit
All Columns on One Page’ and Change document to Landscape Orientation.
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