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Correspondence templates

Updated on April 23, 2021

Similar to SLAs the correspondence templates are selected based on the member's line of business.

Pega Foundation for Healthcare

SendDecisonNotification decision table defines which correspondence templates will be sent.

When user selects the Medicare LOB, the following correspondence templates will be used:

  • NotifyDecisionGrievanceDissmissedGVT
  • NotifyDecisionGrievanceApprovedGVT
  • NotifyDecisionGrievanceWithdrawnGVT
  • NotifyDecisionAppealApprovedGVT
  • NotifyDecisionAppealDeniedGVT
  • NotifyDecisionAppealDissmissedGVT
  • NotifyDecisionAppealPartialGVT
  • NotifyDecisionAppealWithdrawlGVT

For all other LOB's, the following correspondence templates will be used:

  • NotifyDecisionGrievanceDissmissed
  • NotifyDecisionGrievanceApproved
  • NotifyDecisionGrievanceWithdrawn
  • NotifyDecisionAppealApproved
  • NotifyDecisionAppealDenied
  • NotifyDecisionAppealDissmissed
  • NotifyDecisionAppealPartial
  • NotifyDecisionAppealWithdrawl

Assignment of Representative (AOR) template

When the user selects either the Medicare, Medicaid, or Federal Program LOB, the GVT_AOR template will be used and for all other LOBs, the Commercial AOR template is used.

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