930 - Review, Referrals, Other

General: EP 930 applies to reviews and issues where no other EP is applicable and where the appropriate EP credit has already been taken to include the following:

• missed issues or prematurely cleared EPs
• correction of previous erroneous actions identified during quality review

Important:  Missed issues are not unadjudicated discovered claims.  A missed issue is an issue that was received while an appropriate EP was pending, but not adjudicated.

Actions to take for missed issues or prematurely cleared EPs and corrections of previous erroneous actions:

• If a subsequent claim is received while an EP 930 is pending for the same contention, process the claim under the pending EP 930.
• If the new claim is for a different contention or claim type (rating vs. non-rating vs. fiduciary)
  • establish the appropriate fiduciary, rating, or non-rating EP, and
  • leave the EP 930 pending for correction of the error.
• If a fiduciary, rating, or non-rating EP is pending, and a missed issue is identified, then establish EP 930 to control the missed issue.
• A VBMS permanent claim associated note must be added for the following:
  • an explanation for establishing an EP 930
  • an explanation for canceling an EP 930
  • the rationale for changing the DOC for an EP, and/or
  • the corrective action taken, date of action taken, and station number of the station that completed the corrective action for all EP 930 corrections.

Notes:

• EP 930 and the appropriate fiduciary, rating, or non-rating EP can be pending concurrently in these scenarios.
• Hubs must utilize the claim label FID – Rev Misuse Other to control for concurrence on misuse debt revisions and all other misuse-related corrections.

Reminders:

• The contention on a new claim must be validated as being different from the contention on the EP 930 prior to establishing the rating or non-rating EP.
• The appropriate claim label must be used as shown above.