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Complaint - UC 2: Hold case for missing AOR

Updated on January 31, 2022

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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