MedNet

For Exception Approvers

​​What You Need to Know Before You Review

If you have been designated an "Exception Approver" in TTPS, your role is to determine if "Service Provider" (e.g. clinical faculty member) payment arrangement exceptions from the Compensation Terms are formally approved or denied. You approve, deny, or return for revision expectation usages on an activity track. In doing this, you are responsible for:

  • Ensuring the appropriate use of exception service providers;
  • Analyzing and verifying the reason for the exception to the Compensation Terms;
  • Completing your review and approval within the designated time periods;
  • Escalating recurring exceptions that could be integrated into normal policies and procedures; and
  • Ensuring required updates to service provider profiles are communicated to Capture Support.

A full explanation of the responsibilities of all roles in the TTP process can be found in the TTP Roles and Responsibilities document.

What Happened Before Your Review

If you are reviewing an activity track, an activity tracker has indicated that one or more of the service providers included in the track is being compensated in exception to the payment arrangement recorded in TTPS. Activity trackers are required to provide a reason as to why they have entered the service provider as an exception.

Review

What to Consider When Reviewing Tracks

You are required to review any tracks that have service providers with exception payment arrangements indicated. Exception payment arrangements may include education contracts, or instances when a service provider has multiple payment arrangements. There may also be other examples unique to your unit. The activity tracker will have made a comment explaining why they made this exception. For each track, you must review the exception reason, make a determination and take one of the following actions:

  • Approve the track if the exception case is valid;
  • Return the track for revision by an activity tracker who will resubmit it; or
  • Deny the track if there is a reason why the track should not have been created.

If you deny a track, it will be stopped in the process. It does not return to an activity tracker or move on to an Activity Validator. It is kept as a record in the system. If the situation requires a follow up, you have to contact the activity tracker.

If you do not take action on an activity track, it will remain in your queue until an action is taken or the validation & authorization period expires. If you do not action on a track by the time the validation and authorization period expires, the track will not be captured in the service provider's statement, and any associated payments will not be made. In this case, the track state will change to "Expired - System Closed" and the track will remain as record in the system for your reference.

If there are frequent exception cases for certain service providers, you can request that a comment be made on their profile so it is easier for you and the activity tracker to determine if it is a valid exception case. You can submit your request via the Change Request Tool.

What Happens Next?

If you approve an activity track, it is sent to the Activity Validator for final approval. The track state will change to say "Pending Validation." If the Activity Validator approves, the track appears on a service provider's statement. At this phase the track state will say "Pending Review."

Activity Validator Returns Track 

An Activity Validator may determine that an activity track needs to be returned for revision. In this case, you would be required to re-approve any exceptions associated with that track before the track can continue on to validation and appear on the service provider’s statement.

Service Provider Submits An Inquiry

Service providers are able to query their activity tracks with the Activity Validator, who may return it to the Activity Tracker for revision. If an activity track with an exception is revised you will be required to review and approve the changes made by the Activity Tracker by the deadline

System Guide Video