RFS Questions
Step | Action |
1 | Provider completes RFS in the app |
2 | RFS is reviewed by clinical (John G.)
|
3 | RFS is uploaded to HSRM for VAMC review
If… | then… | VAMC approves RFS | New referral will be uploaded to HSRM and will be accepted | VAMC denies RFS | Most VAMC’s email Myra the denial letter and ZCC and Kustomer will be updated with the denial info. |
|
Questions from Veterans
1. “ The VA is telling me they are still waiting on paperwork from Zeel. Please help me get scheduled.”
Step | Action |
1 | Check if RFS is uploaded to HSRM |
2 | Review ZCC and Kustomer for notes indicating referral was denied or in a pending decision status.
If… | then… | RFS is uploaded (less than 3 months ago) and no notes indicate the referral was denied | Respond to the veteran:
“Thank you for bringing this to our attention. We have sent an RFS to your VA and provided all necessary documents. Please reach out to your VA directly for future status updates. Thank you for your service and we look forward to helping schedule you soon. “ | RFS is uploaded and notes indicate the referral was denied | Respond to the veteran:
“Thank you for bringing this to our attention. We sent an RFS to your VA and provided all necessary documents. They notified us of their decision to deny a new referral. Please reach out to your VA for further clarification”
You will also be able to view a copy of the letter of denial in ZCC in the “Attached files” area in the referral tab if you need more information, dates, etc. | RFS is not uploaded
*Be sure to check the medical review tab or tasks tab in case it was sent back for corrections, never uploaded etc. If it is “Accepted” you can go ahead and upload.
*Sometimes an RFS is not in HSRM and the status is “FINAL” in the medical review tab. That could be an issue that needs to be added to the production sheet so the copy of the RFS can be obtained and uploaded. | Respond to the veteran: “Thank you for bringing this to our attention. We have sent the RFS and all necessary documentation to your VA for review. Please reach out to your VA directly for future status updates. Thank you for your service and we look forward to helping schedule you soon” | RFS is uploaded (more than 3 months ago), referral is expired and no notes indicate the referral was denied | Slack Myra to contact VAMC to find out more info. | You are unsure if contact with the VA is necessary | Post to actually-patient-care Slack Channel |
|
