Take the following actions within one day of receipt of an FDC that has a b. Initial Actions to Take claims folder Upon Receipt of an FDC for establish the appropriate EP Claims With enter specific contentions of the claim Paper Claims identify the claim as an FDC by attaching the Fully Developed Claim Folder special issue indicator to within the FDC claim at least one contention complete the folder flash shown in M21-1, Part III, Subpart i, 3.B.6 and attach it to the paper claims folder, and deliver the paper claims folder to the designated drop-off point for FDCs that require the development described in M21-1, Part III, Subpart i, 3.B.3. A paper claims folder is a claims folder that has yet been scanned Note: not into the electronic claims processing system. For more information about References: choosing an appropriate EP, see M21-4, Appendix B establishing an EP in the appropriate system, see M21-1, Part III, Subpart ii, 2.D.2, or drop-off points for FDCs, see M21-1, Part III, Subpart i, 3.A.3.c. 2. Excluding Claims From the FDC Program Introduction This contains information about excluding claims from the FDC Program, including excluding a claim from the FDC Program at CEST reasons for subsequent exclusion of a from the FDC Program submission of additional evidence and FDC exclusion process for excluding a claim from the FDC Program special issue indicators and required notification text for FDC exclusion erroneous exclusion of a claim from the FDC Program, and applicability of FDC guidance changes. Change Date November 18, 2015 a. Excluding a Even though a claimant submits one of the EZ forms listed in M21-1, Part III, Claim From the Subpart i, 3.A.2.a, the claim must be reviewed at the claims establishment FDC Program (CEST) stage to ensure it qualifies for FDC processing. at CEST
b. Initial Actions to Take Upon Receipt of an FDC for Claims With Paper Claims Folder Take the following actions within one day of receipt of an FDC that has a claims folder establish the appropriate EP enter specific contentions of the claim identify the claim as an FDC by attaching the Fully Developed Claim special issue indicator to at least one contention within the FDC claim complete the folder flash shown in M21-1, Part III, Subpart i, 3.B.6 and attach it to the paper claims folder, and deliver the paper claims folder to the designated drop-off point for FDCs that require the development described in M21-1, Part III, Subpart i, 3.B.3. Note: A paper claims folder is a claims folder that has not yet been scanned into the electronic claims processing system. References: For more information about choosing an appropriate EP, see M21-4, Appendix B establishing an EP in the appropriate system, see M21-1, Part III, Subpart ii, 2.D.2, or drop-off points for FDCs, see M21-1, Part III, Subpart i, 3.A.3.c. 2. Excluding Claims From the FDC Program Introduction This contains information about excluding claims from the FDC Program, including excluding a claim from the FDC Program at CEST reasons for subsequent exclusion of a from the FDC Program submission of additional evidence and FDC exclusion process for excluding a claim from the FDC Program special issue indicators and required notification text for FDC exclusion erroneous exclusion of a claim from the FDC Program, and applicability of FDC guidance changes. Change Date November 18, 2015 a. Excluding a Claim From the FDC Program at CEST Even though a claimant submits one of the EZ forms listed in M21-1, Part III, Subpart i, 3.A.2.a, the claim must be reviewed at the claims establishment (CEST) stage to ensure it qualifies for FDC processing.
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