Veterans' Affairs Processing (VAP) quality checking 111-22190000

Services Australia uses digitally enabled processing (DEP) to create a PaNDA work item ready for allocation.

To receive a new work item for quality checking in Work Optimiser Worklist, Quality Checker to select the Ready button once.

For more information, see Work Optimiser for staff.

Note: the auto operator numbers are not uploaded in PaNDA for checking.

See the Resources page for information on the available reports.

When selecting a PaNDA work item from Worklist, staff with relevant skill tags in PaNDA are automatically redirected to the Work Item and Document Details screen.

To open documents associated with the work item:

• Select the Document ID line to view the document image
• A new window will open and display the document in a tabular format
• Information on the right of the table will have all the details from RMDS needed for checking the work

When staff:

• receive their own work item for checking:
• add a processing note to the PaNDA record 'own work' and select Save
• seek assistance from another Local Peer Support (LPS) to have their work checked and reassign the work item to that staff member using reason code 'Service Support Referral'

or

• do not have the appropriate skills to check the Community Nursing work item, select 'Proficiency Raised'

Using the CICS mainframe, locate the claim to be checked:

Key VQRF, provider number, claim ID and press [Enter].

The Veteran claims for Provider screen displays.

Check the 'C' field.

Is the 'C' field blank?

Note: blank indicates manual claim.

• Yes:
• Key 'C' in the 'S' field and press [Enter]
• Go to Step 4
• No, it displays 'A', 'D', 'H', 'I', 'N', 'O' or 'W', see online claims quality checking procedure below

The VCEI screen displays the following details of the Service Officer who processed this claim:

• Source office code in the OPER REF field
• Service Officer number at the far right side of the claim line

Locate the claim paperwork. All manual paperwork received is scanned and stored in PaNDA for processing.

For manual claims processed via PaNDA, search for the work item.

Once the claim paperwork has been located, see Table 2 > Step 1.

Using the CICS mainframe:

• Key: 'VPSI, <provider number>,<claim ID>,DOL=ddmmyy'
• Press [Enter]

The duplicate Provider statement displays.

Check History screen:

• clear screen
• key VHOI, <DVA file number> without spaces

Comparing the claim paperwork, perform a quality check to confirm:

• claim header details have been keyed correctly
• relevant signatures
• all services paid or rejected have been assessed according to the business rules and policy requirements
• the correct use of processing indicators, reason codes on history and claim statement
• payment has been made in accordance with Veteran's White Card accepted disabilities (Quality checker will need to verify VAP eligibility rules applied correctly)

Note: for quality checking, if a Service Officer enters multiple services for the same patient, this is counted as +1 sample. See Quality checking sample count.

For manual claims processed via PaNDA, add a note on the work item indicating quality check and feedback completed. See Table 2 in the Processing and National Demand Allocation (PaNDA).

For post-checks, record the transaction in the VAP Quality reporting form and in the VAP Quality Checking Performed email template.

Complete and submit the Veterans' Affairs Processing (VAP) Quality Reporting form.

Complete the VAP Quality Checking Performed email template and forward to:

• the Service Officer who completed the work, and
• cc the Service Officer’s Team Leader

On completion of quality checking, update the status to Complete on the Work Item and Document Details screen:

• select Complete in the Status field
• select Save

A message will display at the bottom of the screen advising that the work item has been successfully saved.

It may take several minutes for the work item to disappear from the Worklist.

Using the CICS mainframe, key:

• key: 'VPSI, <provider number>,<claim ID>,DOL=ddmmyy'
• press [Enter]

The duplicate Provider statement displays.

Press F2 on the file numbers to identify if the service was paid by a Service Officer.

Note: services paid by the auto-operator are not to be quality checked.

The Processing References details are displayed.

Locate the service line to be checked on veteran’s history.

Place cursor on the letter appearing in the TX field and press [PF1]

Note: the TX field display options are:

• T - service text only
• B - Both service text and other text present for the service line
• O - No service text present, but other text present for the service line
• Blank - No text or other fields present for the service line

Any text messages or VQME entries appear at the bottom of the screen.

Check VQME entries for supporting data.

On a blank CICS mainframe screen:

• key: 'VQME, <provider number>,<claim ID>,DOL=ddmmyy'
• press [Enter]

VQME data displays on the DVA Claims Message Enquiry Display screen.

Comparing the transmitted data (VQME), perform the check to confirm:

• all services paid or rejected have been assessed according to the business rules and policy requirements
• the use of correct processing indicators, reason codes on history and claim statement
• payment has been made in accordance with Veteran's White Card accepted disabilities (Quality checker will need to verify VAP eligibility rules are applied correctly)

For post-check, record transaction in the VAP Quality reporting form and in the Quality Checking performed email template.

Complete and submit the VAP Quality Reporting form.

Complete the VAP Quality Checking Performed email template and forward to:

• the Service Officer who completed the work, and
• cc the Service Officer’s Team Leader

On completion of quality checking, update the status to Complete on the Work Item and Document Details screen:

• select Complete in the Status field
• select Save

A message will display at the bottom of the screen advising that the work item has been successfully saved.

It may take several minutes for the work item to disappear from the Worklist.