Refer all claims for adaptive equipment to the finance activity. It will f. Referring Adaptive determine if the adaptive equipment is preapproved for reimbursement based Equipment upon the effective date of entitlement, the SC disability, or if it is Veteran’s Claims to the specifically authorized by the local VA outpatient clinic. If it is not, then the Finance finance activity will forward the claim to the outpatient clinic serving the Activity applicant's residence. The designee of the Chief Medical Director will consider the claim. The prosthetic department will signify its approval by completing This form is then returned to finance for VA Form 10-1394. payment. These claims may be independent of any initial application for an automobile, and may involve repair, replacement, or reinstallation of adaptive equipment. 7. Processing Notice of Disagreements (NODs) or Substantive Appeal Change Date November 16, 2004 a. Processing Use the table below to determine the next steps when the claimant files an an NOD or NOD or substantive appeal relating to the denial of a claim for automobile Substantive and adaptive equipment allowance. Appeal If Then … … the disallowance resulted from the authorization furnishes the statement denial of basic eligibility of the case (SOC) and certifies the appeal when the substantive appeal is received. the claimant has established basic authorization transfers the claims eligibility to the automobile folder to the medical facility for allowance and adaptive equipment, preparation of an SOC, and and the medical facility returns the the issue is the result of SOC and claims folder to disallowance by the medical authorization for release of the activity for certain adaptive SOC. equipment a substantive appeal is filed because authorization forwards the claims of disallowance by the medical folder to the medical activity for activity processing and certification of the appeal.
f. Referring Adaptive Equipment Claims to the Finance Activity Refer all claims for adaptive equipment to the finance activity. It will determine if the adaptive equipment is preapproved for reimbursement based upon the effective date of entitlement, the Veteran’s SC disability, or if it is specifically authorized by the local VA outpatient clinic. If it is not, then the finance activity will forward the claim to the outpatient clinic serving the applicant's residence. The designee of the Chief Medical Director will consider the claim. The prosthetic department will signify its approval by completing VA Form 10-1394. This form is then returned to finance for payment. These claims may be independent of any initial application for an automobile, and may involve repair, replacement, or reinstallation of adaptive equipment. 7. Processing Notice of Disagreements (NODs) or Substantive Appeal Change Date November 16, 2004 a. Processing an NOD or Substantive Appeal Use the table below to determine the next steps when the claimant files an NOD or substantive appeal relating to the denial of a claim for automobile and adaptive equipment allowance. If … Then … the disallowance resulted from the denial of basic eligibility authorization furnishes the statement of the case (SOC) and certifies the appeal when the substantive appeal is received. the claimant has established basic eligibility to the automobile allowance and adaptive equipment, and the issue is the result of disallowance by the medical activity for certain adaptive equipment authorization transfers the claims folder to the medical facility for preparation of an SOC, and the medical facility returns the SOC and claims folder to authorization for release of the SOC. a substantive appeal is filed because of disallowance by the medical activity authorization forwards the claims folder to the medical activity for processing and certification of the appeal.
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