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Reimbursement Guidance. Work Authorization. Purpose. Clarify the Work Authorization Process Understand updates/changes to the Work Authorization Process Understand how to use the 007 AAF. Objectives. Review the work authorization process Explain proper use of Proposed and Contingent Units - PowerPoint PPT Presentation
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Reimbursement GuidanceWork Authorization
Purpose
Clarify the Work Authorization Process
Understand updates/changes to the Work Authorization Process
Understand how to use the 007 AAF
Objectives
Review the work authorization process
Explain proper use of Proposed and Contingent Units
Explain how incomplete or deficient reports are to be handled
Explain use of the new 007 AAF
Definitions
Pre-Approval = Authorization = Pre-Authorization Work Performance Period = the start and end of a
phase or sub-phase; has nothing to do with reimbursement
The Work Authorization Process:“pre-approval”
ReleaseReported
DEQ AssignsPC# and
Case Manager
Consultant/RPand DEQdiscuss
Work Scope
ConsultantPrepares/edits
Scope/AAF andsubmits to
DEQ
DEQ reviewsScope/AAF
Scope/AAFOK?
NO
Consultant/RPAnd DEQSign AAF
YES
Work
!
• Proceed @ own risk• Discuss with GWM• RP to cover $
Confirmed Release Letters
For combined IA/SCR Reports, DEQ Case Managers will specify a single due date
For separate IA and SCR Reports, DEQ Case Managers will specify separate due dates for the deliverables
AAF Pre-Approval
DEQ & Consultant/RP discuss scope
Consultant/RP develops AAF DEQ reviews AAF and discusses
needed changes w/ consultant/RP Consultant/RP amends AAF as
necessary DEQ signs AAF and returns to
consultant/RP
The Work Authorization Process:“change in work scope”
SiteConditions
RequireChange/Increase
In scope
Consultant/RPContacts DEQ
Case Manager to Get approval for
Additionalunits
Contingent UnitsSufficient? NO
YES Work
WorkConsultant/RP
documentsApproval!
Approvalreceived?
YES
NO • Proceed @ own risk• Discuss with GWM• RP to cover $
Proposed and Contingent Units
Proposed Units Units to complete entire work scope Based upon existing knowledge of site
Contingent Units Units for reasonable changes to work
scope Changing or unknown site conditions Circumstances arising during work Rationale for use must be supported
The Work Authorization Process:“verification”
Consultant/RPSubmits
Deliverable &Work-performed
AAF to DEQ
DEQCase Manager
Reviewsdeliverable
NO
YES
DEQ CaseManager
Verifies AAF(30 days)
DeliverableComplete?
Work
DEQ CaseManager
Sends VAAF toDEQ CO
DEQ CaseManagerConveys
Denial info to Consultant/RP
To Reimbursement
AAF Verification
DEQ Case Managers may request additional documentation
Consultant/RPs must document rationale for contingent unit use
DEQ Case Managers must document rationale for denials (comments field)
DEQ Case Managers have 30 days to complete
Deliverables
Deliverables must be well defined at time of pre-authorization
Deficient deliverables shall be returned for completion – no additional units authorized
Addenda – additional units shall be authorized for expanded/new scope of work
Deficient Reports
Standard and/or requested report items missing with no rationale
Incorrect work, e.g. calculations are wrong, improper well construction, contours are wrong, etc
Poor quality, e.g. illegible, obviously boilerplate (wrong references, not site specific), report is self-contradictory, missing rationale, unsupported conclusions
Deficient Reports (cont)
Supporting documents missing, e.g. analytical reports, manifests, correspondence, access agreements, photos, field logs, etc Incorrect work, e.g. calculations are wrong, improper well construction, contours are wrong, etc.
Incomplete scope of work (field work)
Addenda
New/additional work needed - not in original scope of work
Phased approach being used Unforeseen circumstances: e.g.
undocumented utilities encountered, weather difficulties, land use or planned land use affecting scope of work (use or planned use not in existence before finalizing scope of work)
The 007 AAF
Landscape format No pre-printed T-Codes Scope of work broken into Activities
New field order - Code and Description
Separate comment fields
The 007 AAF
Monitoring Well InstallationM0089 Equip Mob/demob event 1 1 Possible 2nd wk drilling
M0123 5 in. mon well inst foot 80 4 wells @ 20’/ 60
X001 Titanium Widget unit 1 Est. cost = $250
The 007 AAF
Reimbursement Period
Jan Feb Mar Apr May Jun
AAFAAF
LabInvoice
LabInvoice
ReportWriting
ReportWriting
Sub-Phase Period
Phase Period
Electronic AAF
Microsoft Excel spreadsheet Automatically populates code
descriptions Documents tracking of changes Summarize Total units Easily emailed
The Work Authorization Process:“Reimbursement”
ClaimantPrepares a
ReimbursementClaim Package
ClaimantSubmits ClaimTo DEQ CO
NO
YES
ClaimComplete?
From:Verification
Process ClaimAnd
Yield Decision
DEQ COQA/QCs claim
Decision
Reject Claim orRequest
Additional infofrom
Claimant
VAAFReceived from
RO? DecisionMailed
Return Claim to Claimant
YES
NO
ClaimPassesQA/QCNO
YES
Payment
The Work Authorization Process:“Reconsideration”
ClaimantReceives
ClaimDecision
SeekRecon?
From:Reimburse-
ment
DEQ CO copies docs to RO
ClaimReviewed
Claimant FilesReconsideration
Claim & SupportingDocs to DEQ CO
(45 days)
AdditionalInfo
Needed?
Analyze Claim,Render a
Draft Decision
NO
YES
PaymentStop
RO Reviews &Responds to
DEQ CO
Decision &Conversion ltrTo Claimant
PanelType?
Panel Convenes &
Renders FinalDecision
ROInput
Needed?
DecisionMailed
YES
NO
NO
YES
M
W
Transition to Sub-Phases
Jan Feb Mar Apr May Jun
PSCRMon Sub-Phase Period198 SCR
Jul Aug Sep Oct Nov Dec
PSCRMon Sub-Phase Period
PSCRMon Sub-Phase Period
2007
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