RFA walkthroughs
Match responses and post treatment decisions
Review an incoming response, match it to the right RFA, record treatment decisions, and complete Post UR.
Before you start
- You need access to the RFA task board, incoming responses, and permission to update RFAs.
- Have the response document and enough patient, claim, and treatment information to confirm the match.
- Use the decision documented in the response. Receiving a fax does not itself establish approval.
Numbered red outlines identify the controls used in each step. Select any screenshot to enlarge it.
1Open the task board and response inbox
Open Tasks & response inbox. Use Due, Scheduled, and Completed to find the work you need. Task type narrows the list, including No response tasks for unanswered requests. For an incoming response, choose Review fax. A follow-up date is separate from days-since-sent aging on the overview.
The task board and unmatched response inbox appear together. Tasks show their saved follow-up dates.
2Match the response to the correct request
Review the document using Open Incoming utilization review response PDF or Download PDF above these controls. Search by patient, claim, or RFA if necessary. Select the exact Matching request and use Review selected request to compare its details. Confirm that the patient, claim, and requested treatment match, then choose Match response and open Post UR.
The response is associated with the selected request and Post UR opens. Matching does not record a treatment decision.
3Record each treatment decision
Confirm the Utilization review response document and enter the decision time. If confirmed receipt evidence is missing, record it before posting decisions. For each treatment addressed by the response, select the decision and enter its supporting information. Denied or modified decisions require the additional information and independent medical review form requested by the form. Choose Save treatment decisions.
The addressed treatment shows its saved decision. Treatments not addressed remain pending. Saving decisions does not complete the response-review task.
4Complete the Post UR response review
After recording all decisions in this response, find its Post UR task. Set Response review to Confirm all decisions have been recorded, check the confirmation, add a follow-up note, and choose Complete response review. If the document has no new treatment decision, use Confirm no new treatment decision instead. Use the follow-up contact option when more work is needed.
The response-review task completes after the reviewer confirms the document was fully reviewed. Logging follow-up contact alone does not complete it.
5Verify the completed task
Return to Tasks & response inbox and choose Completed. Find the Post UR task, completion time, and response filename. Review response reopens the request and its evidence.
The completed review appears in Completed, and the matched fax is no longer in the unmatched inbox. Task completion does not imply every treatment was approved.
What these screenshots verify
Read the verification record for capture details and checks. Your application may use different colors, permissions, or enabled features.