EEOICPA BULLETIN NO.  04-11          

 

Issue Date: June 18, 2004

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Effective Date: June 16, 2004

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Expiration Date: June 18, 2005

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Subject:  The use of Reason Codes for the 'DE' and 'NR' claim status codes in ECMS.

 

Background:  This bulletin supplements the following: 

Bulletin 02-13 "Chronic Lymphocytic Leukemia Cases;" Bulletin 03-07 "Employment Verification Codes;" Bulletin 04-01 "Instructions for Reworks of NIOSH Dose Reconstruction Reports."  Unless otherwise discussed herein, all coding information provided in those bulletins remains applicable.

 

The reason code field in ECMS was introduced to further expand the definition of certain claim status codes.  Two codes that require additional qualification upon entry in ECMS are the 'DE' (Developing Employment) and 'NR' (Received from NIOSH) codes.  It is not enough just to select the claim status codes as before, since now there are multiple meanings for each of these codes.  This bulletin will introduce and explain specific reason codes to use upon data entry of the 'DE' and 'NR' claim status codes in ECMS. 

 

References:  ECMS FAQs (Frequently Asked Questions) on the DEEOIC shared drive, Bulletin 02-13 "Chronic Lymphocytic Leukemia Cases;" Bulletin 03-07 "Employment Verification Codes;" Bulletin 04-01 "Instructions for Reworks of NIOSH Dose Reconstruction Reports."

 

Purpose:  The claims examiners will now be required to select a reason code in conjunction with the 'DE' and 'NR' claim status codes in ECMS. The purpose of this bulletin is to introduce instructions for capturing more specific information when coding in ECMS, applicable to the use of these claim status codes.

 

Applicability:  All staff.

 

 

 

Actions:

 

1.                    The 'DE' claim status code.  When developing initial or follow-up employment directly with the claimant, or as a follow-up to the Department of Energy (DOE), a corporate verifier, the Social Security Administration (SSA) or the Center to Protect Workers' Rights (CPWR), the CE enters the 'DE' (Developing Employment) claim status code in ECMS.  The status effective date of the 'DE' code is either the date of the letter to the claimant, or the date of the follow-up action to the employment verifier.  (This process has not changed.)

 

2.    Upon entry in ECMS of the 'DE' code, the CE will now be required to select a specific reason code from the "reason cd" field.  This field is a drop-down box that corresponds with the 'DE' claim status code.  Included in the reason cd field are both the full reason for the 'DE' code and a two-digit code representing each option.  

 

3.    The reason codes available for the 'DE' claim status code are as follows: 

 

      a)  Letter directly to claimant(s)-‘LE’:  This is used for initial

      or follow-up letters mailed directly to the claimant, when asking

      for employment clarification or information.

 

      b)  Follow-up to DOE-‘DE’:  This is used exclusively for follow-up

      to the DOE.

 

      c)  Follow-up to Corporate Verifier-‘CS’:  This is used exclusively

      for follow-up to a Corporate Verifier.

 

      d)  Follow-up to CPWR-‘US’:  This is used exclusively for follow-up

      to CPWR.  

 

      e)  Follow-up to SSA-‘SS’:  This is used exclusively for follow-up

      to the SSA, when sending a follow-up request to National Office. 

 

4.    The CE selects the specific reason for the use of the 'DE' code from the reason cd field upon entry in ECMS.  The two-digit reason code and the 'DE' reasons are included on the same line, so only one selection will be made from the drop-down box. 

 

 

 

 

Two Digit 'DE' reason code

DE reasons

LE

Letter directly to claimant(s)

DE

Follow-up to DOE

CS

Follow-up to Corporate Verifier

US

Follow-up to CPWR

SS

Follow-up to SSA (through NO)

 

 

4.    The 'NR' claim status code.  When a case is returned from NIOSH with a dose reconstruction or when, after full medical development, the only claimed primary cancer is CLL, the CE enters the 'NR' (Received from NIOSH) claim status code in ECMS.  For the former, the status effective date is the date the dose reconstruction is date-stamped in the district office.  For the latter use of the 'NR' code, the status effective date is the date of the Recommended Decision to deny based on CLL.  (This process has not changed.)

 

5.    Due to the new process of 'Reworks of NIOSH Dose Reconstruction Reports' (see Bulletin 04-01), there are times when a dose reconstruction will be received in the district office, and is found to be in error.  If it is determined that the received dose reconstruction is not to be used, based on the review by the Health Physicist at National Office, ECMS needs to reflect that even though the 'NR' code was entered, a POC will not be entered in ECMS, and the case will eventually be reworked by NIOSH.

 

6.    Upon entry in ECMS of the 'NR' code, the CE will now be required to select a specific reason code from the "reason cd" field.  This field is a drop-down box that corresponds with the 'NR' claim status code.  Included in the reason cd field are both the full reason for the 'NR' code and a two-digit code representing each option.

 

7.      The reason codes available for the 'NR' claim status code are as follows: 

 

a)  Dose Reconstruction received, POC-‘DR’:  This is used when the dose reconstruction is received in the district office. (Even though the CE might not have had an opportunity to review the dose reconstruction report yet, this is the appropriate reason code to use at this time.) Note: This code is used on every case returned from NIOSH,even if it must eventually be changed (see (b) below.)

     

b)  Reworks of Dose Reconstruction, no POC-‘RW’:  This is used exclusively if it is determined that the received dose reconstruction is not to be used, based on the review by the Health Physicist at National Office.

 

      Once the Health Physicist determines that the case must be

      returned to NIOSH for a rework, the CE changes the reason code

      for the 'NR' claim status   code from ‘DR’ to ‘RW.’ (Note: A new

      'NR' claim status code is not to be entered in ECMS.  Only the

      reason code for the existing 'NR' code is to be updated.)

 

      Once the rework is prepared by the CE and a new Amended NIOSH

      Referral Summary Document (ANRSD) is ready to be forwarded back

      to NIOSH, a new 'NI' claim status code is entered in ECMS, with

      a status effective date of the ANRSD.

       

c)  CLL only, no POC-‘CL’:  This is used exclusively for cases never sent to NIOSH, where the only claimed cancer condition is CLL. 

 

8.    The CE selects the specific reason for the use of the 'NR' code from the reason cd field upon entry in ECMS.  The two-digit reason code and the 'NR' reasons are included on the same line, so only one selection will be made from the drop-down box. 

 

 

Two Digit 'NR' reason code

NR reasons

DR

Dose Reconstruction received, POC

RW

Reworks of Dose Reconstruction, no POC

CL

CLL only, no POC

 

       

9.    Back-fill will not be required for the 'DE' code.  There will be a programmatic back-fill done for the 'NR' code.  However, there will be some cases that cannot be programmatically updated, and those cases will need to be reviewed and updated in the district offices.  Once compiled, a list will be provided to each district office of those cases requiring manual back-fill entry.  

 

Disposition:  Retain until incorporated in the Federal (EEOICPA) Procedure Manual.

 

 

 

 

 

 

 

PETER M. TURCIC

Director, Division of Energy Employees

Occupational Illness Compensation

 

 

 

 

 

 

 

Distribution:  Distribution List No. 1:  (Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections.)