TN 28 (09-16)

GN 04440.405 Request for Program Consultation (RPC) Process Description

The purpose of the RPC process is to resolve deficiency disagreements between an adjudicating component and a reviewing component in fully electronic cases. The RPC process is not a “de novo” review. If the adjudicating component determination is policy compliant, the deficiency is rescinded. If the adjudicating component determination is not policy compliant, the RPC panel considers whether the deficiency cited by the review component is policy compliant. If the deficiency is policy compliant, the RPC panel affirms the deficiency. If neither component’s actions are policy compliant, the RPC resolution document directs the review component to correct the cited deficiency and addresses the policy compliant actions that the adjudicating component must complete. In this instance, the deficiency type is changed, i.e., corrected, in the OQR case processing system, but not rescinded. At no time is more than one deficiency recorded in the quality review database for performance accuracy purposes.

See Details

For additional policy guidance on the RPC process, see DI 30007.000 Request for Program Consultation.