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Common - UC 8: Communicate appeals resolution

Updated on January 31, 2022
Pega Foundation for Healthcare
  1. Enter effectuation date. Effectuation date captures the effective/applicable date of appeal’s decision.
  2. Select Receiver, Mode of communication, and correspondence letter.
  3. Enter oral, and written notification date and click Submit.
  4. System generates acknowledgement letter and makes a copy of it available in attachments section.

    Communication of grievance and determination resolution is similar. Grievance resolution does not display effectuation date.

  5. If the user selects the Edit correspondence link under the selected Channel, the system will display the generated letter in an editable format. The user may then edit both content and formatting for the letter. When satisfied with the customization of the displayed letter, the user clicks on Submit.
    Note: Edit Correspondence link is available for ‘Mail’ mode of communication only.

  • Previous topic Appeal - UC 7: Perform medical review of an appeal
  • Next topic Appeal - UC 9: Download appeal case packet

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