EEOICPA
BULLETIN NO. 04-11
Issue
Date:
________________________________________________________________
Effective
Date:
________________________________________________________________
Expiration
Date:
________________________________________________________________
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-
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.
Distribution: Distribution List No. 1: (Claims Examiners, Supervisory Claims
Examiners, Technical Assistants, Customer Service Representatives, Fiscal
Officers, FAB District