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Complaint - UC 4: Move case out of PendingAOR workbasket

Updated on January 31, 2022
Pega Foundation for Healthcare
  1. Retrieve the case from PendingAOR workbasket.

    AOR letter is received/available.

  2. Check “AOR received” checkbox and updated AOR related information such as AOR received date, AOR effective date and AOR expiry date.

  3. User saves the case.
  4. System updates "Actual organization receipt date" based on AOR received date.
  5. System generates an appeal, determination, or a grievance subcase.

    If AOR is not available and still user wish to proceed with complain resolution, then user may opt to skip AOR requirement. User may check the “Skip AOR” checkbox and system will allow child case creation without AOR availability.

  • Previous topic Complaint - UC 3: Follow-up for AOR form
  • Next topic Appeal - UC 5: Review and research appeal information

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