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

Type 'RMDS' in the CICS mainframe.

The RMDS Main Menu is displayed.

Key '4' in the SELECT OPTION field then press [Enter].

RMDS returns a list of reports. See the Resources page for information on the available reports.

Scroll down until the required report is displayed.

• To select the previous day's work, key '1' in the ACTION field for the relevant report then press [Enter]
• Click the EDIT button on mainframe and select Send to Scratch Pad. Personal Communications Scratch Pad (PCSP) will display
• Go back to mainframe, PF8 and repeat the EDIT step until ‘bottom of page’ is reached, with all pages added to PCSP
• PF3 on mainframe, go to the next relevant report and repeat the EDIT step again until all work types have been selected
• On PCSP, click Save and save file on desktop
• Close PCSP then repeat the above steps for each site/location, that is, SA, VIC, WA

Note: to display a list of the reports for other dates of processing, key '3' in the ACTION field then press [Enter].

Press:

• PF3 twice to exit RMDS system
• Pause/Break to clear screen

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

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 this by checking Veterans' accepted disabilities on the VEXI screen

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