Operations and exceptions

The Operations Overview brings pending and attested care requests, review decisions, failed operation receipts and evidence verification into one working screen. Its exception queue helps an Operations Manager open the source request behind a failed operation.

Each guarded action retains an operation key, expected revision, result state and occurrence date. A pending or failed receipt leads to read-first reconciliation against the local request and any actual effect. External inquiry is used only where an external reference belongs to that operation.

• Source. The Operations Manager opens the receipt from the exception queue and reads its parent request, expected revision and operation key before taking action.
• Decision. A Completed result requires a match to the actual local effect. If the operation used an external provider, compare its retained external reference as well.
• Follow-up. Keep a disagreement in needs review and ask the Authorized Clinical Reviewer to decide a correction to executed scope. Do not turn a failed receipt into a fresh instruction.

Agree how long a receipt may remain Pending, who investigates Failed and needs review, and how a correction is authorized. Make the original operation key available to the person reconciling a retry.

Confirm which team member can act for the practice and how staff check the current revision. Rehearse a changed case with the person who receives this handoff.

Rehearse a provider response lost after a successful external action. Compare the original key, local revision and external reference before changing the receipt to Completed. Keep a disagreement visible as needs review.

Have the next person open the linked request and explain what changed, who decided, and which evidence supports the current state. Repeat with a stale revision; the team should return to the current record before acting.

The exception queue should lead back to the receipt and parent request. A receipt marked Failed is an investigation item, not a second instruction to act. Compare its expected revision and any external reference with the actual source and effect before deciding whether the action completed.

• Operations Needing Attention — Failed and needs-review receipts with the action and reason beside the parent request.
• Pending Operation Receipts — Unresolved operations waiting for a check of their actual effects.

See the process and implementation steps for a rehearsal that includes a changed revision and an unresolved response.