Purpose
You can use this report to monitor care insurance claims for a missingcare review visit.
According to German law, insureds must ask for a care review visit atregular intervals if they are claiming/drawing a purely monetary carebenefit. The system checks in which cases a care review visit isrequired, and whether the care review visit has taken place. If no carereview visit has taken place, the system checks whether any permittedalternative evidence exists.
If all checks are negative, the case is placed in mass processing bytrigger 0CTRVS. You can then trigger corresponding actions of theBusiness Rule Framework(BRF).
The check is made as follows:
The system determines the care level of the claimant. The care levelprovides information on the period in which the care review visit shouldhave taken place.
The system checks whether a care review visit has taken place.
If no care review visit has taken place, the system checks whether acare review visit really is necessary, in other words, whether a purelymonetary benefit is being claimed.
If a purely monetary benefit is being claimed, the system checks whetheralternative evidence exists (interruptions, respite care, care providedby substitute, home health care, appraisal).
If no alternative evidence exists, the system places the case in massprocessing.
Notes:

• The system also considers a care review visit to be unnecessary if the
start of the care level is within the period under review or a maximumof one month before, as a goodwill gesture, (see period_get method).

• A care review visit must be requested in absolute periods, in other
words, in every calendar quarter or calendar half-year.

Integration
In mass processing, handler class CL_CONTROL_VISIT_ICL has been enteredfor trigger 0CTRVS. If you want handling to be different, you canreplace this handler class with your own in customizing (in tableTIMP111). If you just want to redefine a few individual methods, you canderive your own class from handler class CL_CONTROL_VISIT_ICL.
In the select method, all open care claims in which the claimant is notdead are checked.

Selection
Mandatory parameters:


• Internal claim type for care (CLTYPE)


• Benefit types for proof of care review visit (NACHWEIS)


• Purely monetary benefit (GELDLEISTUNG)

Optional parameters are the permitted alternative evidence

• HKP = home health care


• VHP = care provided by substitute


• KZP = respite care


• Appraisal

The additional attributes are transferred as parameters as soon as thetrigger is started.

Activities


• Assign a rule set to trigger 0CTRVS in the BRF.

This rule set is then executed when cases without a care review visitare processed. You can define the following actions in the rules of thisrule set, for example:
Reminder letter to the insured
Task for the claim handler
Reduction of the monetary benefit

• At the beginning of each calendar quarter, start the report
RICL_TRIGGER_CONTROL_VISIT that starts the trigger 0CTRVS.