1. Initial Review: The administrative team checks the bill for completeness and basic submission criteria.
2. Eligibility Check: Healthcare professionals and administrators review the bill to ensure it meets guidelines, including medical necessity, compliance, and whether the Annual Unshared Amount (AUA) has been met.
3. Member Appeal Panel: If a bill is deemed ineligible, members can appeal to the Member Appeal Panel for a final decision. This ensures fair and consistent assessment according to the community's guidelines and standards.