Complaint - UC 2: Hold case for missing AOR
If the complaint source is “Authorized representative” then system requires an AOR (Appointment of representative) form with a valid effective date before a complaint case can be processed further.
Pega Foundation for Healthcare
- Complaint intake associate (User) enters Authorized representative related data and
member data, including plan, to process complaint from authorized
representative.
- User fills-in required details such as representative name, address and contact information.
- AOR letter is not received/available.
- User leaves “AOR received” checkbox unchecked and submits the case.
- Case is held in PendingAOR workbasket till the AOR is received or AOR check is
skipped.
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