TCM0070140 | Claims - rejecting: Resurrecting rejected claims

Background

This Action Guide provides guidance on the action to take to resurrect a rejected claim. For example, the claim may have been

• rejected in error during manual capture
  or

• rejected without allowing the full reminder period to expire.

Guidance

To resurrect an incorrectly-rejected claim, consider steps 1 to 6.

Step 1

Create a copy of the rejected claim on the computer. To do this

• select ‘Application’ from the toolbar menu

• select ‘Correction’ from the options available

• enter the customer’s NINO in the Key Entry Data - Applicant screen

• select [OK]. The following message will be displayed ‘Details must be entered in Capture Application function’

• select [Yes]. You will be taken to Function CAPTURE APPLICATION
  then

• go to the Log screen and select [Store]. This will

  • store a copy of the rejected claim on the computer

  • create a copy for you to work on

  • create an entry on the Incomplete Applications work list.

Step 2

Do you require further information in order to process the claim?

• yes, go to Step 3.

• no, go to Step 5.

Step 3

In Function CAPTURE APPLICATION go to the Summary Information screen and establish what previous action has been taken and what information is still required to process the claim.

Check

• the Repair Summary field for details of errors

• the Application Notes field for details of previous action taken
  then

• check

  • the Income screen

  • the Payment screen

  • any manual clerical notes or information on the Claimant Compliance Management Information System (CCMIS), if appropriate
    then

  • go to Step 4.

Step 4

Contact the customer for the information that you need to process the claim. Follow the guidance in TCM0094080 and TCM0094160.

• If you obtain the missing information, go to Step 5.

• If you are unable to obtain the missing information, go to Step 6.

Step 5

In Function CAPTURE APPLICATION enter the missing information on the relevant screens

• update the Application Notes field in the Summary Information screen with the following text
  ‘TCMZ Claim reviewed following incorrect rejection’
  Note: You must follow the guidance in TCM0152060 when you record the note and also follow the guidance in TCM0152040.
  then

• continue to process the claim. Take no further action.

Step 6

If you are unable to obtain the missing information, take the following action

• reject the claim as incomplete. Follow the guidance in TCM0070040 or TCM0070100
  or

• extend the action date if the customer has requested more time to get the information that you need.