Review and evidence

Give every material decision a source revision, reason and traceable effect. A review decision points to the parent policy and records the source revision, reviewer, decision, date, reason and operation key. A returned revision can be corrected and reviewed again while the earlier decision remains intelligible. The underwriter should read the same policy and eligibility context that the coordinator submitted.

• Attach. Insurance Coordinator files policy evidence with an uploader, evidence type and visibility scope.
• Decide. Authorized Underwriter records the source revision, decision, reason and operation key against the parent policy.
• Reconcile. Authorized Underwriter compares a pending receipt with local effects and retained external evidence.

Attachments belong to a policy and carry title, evidence type, upload date, uploader and visibility. Internal and shared material can be kept distinct as the team prepares a case. Operation receipts preserve the action, expected revision, result state, occurrence and effect references. Pending, failed and review-needed receipts are follow-up work until the persisted records and external reference agree.

A review decision belongs to the policy and identifies the revision considered. For an eligibility action, keep the submitted extension in view as well; the extension has its own revision and status. The operation receipt identifies the guarded action and expected revision. Follow up a pending, failed or review-needed result against the recorded effects before attempting the action again.

Agree who may upload shared evidence, what belongs in internal material, and which source revision each decision covers. Define the escalation owner for a pending or failed receipt. Ensure a reviewer is independent of the preparer and that each action has a stable operation key.

When an eligibility submission is returned, the underwriter records the exact revision and reason. The coordinator updates the evidence and submits a new revision. If the later approved action leaves a pending receipt, the underwriter checks the parent policy, coverage effects and any external reference before recording completion. The auditor can reconstruct both decisions and the reconciliation without treating an uncertain result as success.

• Receipts needing reconciliation — Shows actions requiring evidence review.
• Shared policy evidence — Shows policy attachments marked for shared access.

Follow employer eligibility review and policy review and issue. Use the data model to trace each record’s parent and reviewer.