- A Veteran Service Representative (VSR) is responsible for uploading the VA Forms 21-4142/a to the PMR Vault
- The VSR sets a VACOLS Diary 35 days from the upload to the PMR Vault
- DOMA pulls the forms from the PMR Vault, sends the initial request to the Private Healthcare Provider (PHP) via letter, cc'ing the veteran
- DOMA will wait 15 days for a response, then send a follow-up letter on the 16th day to the PHP, cc'ing the veteran
- If there's no response after 15 more days, on the 32nd day, DOMA uploads a Report of General Information to the PMR Vault documenting the inability to obtain a response from the PHP
- The VSR pulls any Report of General Information or PMRs from the PMR Vault, uploads them to the veteran's e-folder, and updates VACOLS
- If there's no action by DOMA during the 35 day diary period set forth in VACOLS, the VSR is responsible for following up, which includes reaching out to the PMR Super User (one person in each RO who oversees the PMR Retrieval Program) for a status update from DOMA
Our Steps to Follow-Up in Light of This Process
- After sending the PMR request to VA/DOMA, review the status of the PMR request in VACOLS, Notes in the client's VBMS E-Folder, and MAP-D after 35 days
- If there's no response (i.e. PMRs or a Report of General Information), send Doc #612 ("First Followup PMR Request - VA & DOMA") and click "DONE" on "Follow-up on PMR Request sent _____" [REPEATER EVERY 30 DAYS].
- Repeat every 30 days as necessary using Doc #610 ("Second Followup PMR Request - VA & DOMA").
If the private provider is giving you a hard time about the cost of the veteran's PMRs, HITECH laws do not apply to applications for veterans disability benefits. Also, federal law states that record requests are capped at $25.00 for veterans cases. In addition, states have different regulations that echo this rule: Mass Gen. Laws Chapter 111 § 70 states: “…no fee shall be charged to any applicant, beneficiary or individual representing said applicant or beneficiary for furnishing a record if the record is requested for the purpose of supporting a claim or appeal under any provision of the Social Security Act or any federal or state financial needs-based benefit program.” (Let them know an application for VA disability comp includes an application for VA pension, which is a federal financial needs-based benefit program).
<<M.A.G.L. - Part I, Title XVI, Chapter 111, Section 70.pdf>>