Correspondence templates
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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