Adjudication is a workflow process in which two (or more) independent people (or teams) make a determination about diagnoses given certain data and criteria. Each team of adjudicators has access to the same data, but can not see the determinations made by others adjudicators until all determinations are complete.

This topic outlines the procedure followed by a person assigned the role of Adjudicator in the adjudication process. For context, you can review the overall process documentation here.

Role Description

An Adjudicator is an individual who reviews details of assigned cases and makes diagnosis determinations. Each adjudicator is assigned to a numbered Adjudication Team which may or may not have a second 'backup' person assigned. The team of one or two people is considered a single "adjudicator" and either person assigned may make the determination for the team. There are usually two, but may be up to 5 teams making independent decisions on each case. Each team makes a determination independently and only when all teams have returned decisions are they compared and reviewed by lab personnel.

If any or all teams make the determination that further testing is required, lab personnel will be notified and when that testing is completed and new data uploaded, all teams will receive notification that a new review and determination is required.

If all teams return matching diagnosis determinations, the case is completed and the diagnosis confirmed and reported to the lab.

If determinations differ, all adjudicators are notified that further review is required. They would typically meet to discuss the details of the case and decide how to handle the case. They might agree to request additional data, or might agree on a diagnosis and update the disagreeing determination(s).

Task List

The basic work flow for an adjudicator is a looping procedure:

    1. Receive and Review Notifications
    2. Review Case Data
    3. Make Determination
    4. Receive Further Notification - either of case closure or need to return to step 1.

Receive and Review Notifications

Notifications can be emailed to adjudicators and also appear in the UI. Email notifications may be turned off by an administrator in case of vacation or other reason to quiet the notifications.

  • Log in to the adjudication folder.
  • Click the Case Determination folder.
  • Review the list of Notifications.

Review Case Data

For each notification:
  • Click View to see the case details. You can also reach the same information clicking Update for any Active Adjudication case listed.
  • Scroll through the provided information. Click links to download any additional information attached to the case.

At the top of the details page, you will also find a Change Active Case pulldown menu allowing you to switch among pending and completed cases assigned to you.

Make Determination

When you have reviewed the available details:
  • Scroll to the bottom of the case detail page.
  • Click Make Determination.
  • In the pop-up window, use pulldowns to enter your determination and add comments as appropriate.

When finished, click Submit.

Receive Further Notification

The case will now appear completed to you, and the original UI notification will have disappeared. The actual status of the case is pending until all adjudicators have made their determinations. When that occurs, you will receive one of the following notifications via email as well as in the Notifications panel on the Case Determination tab:

  • The case is now closed: agreed diagnosis is considered final and reported to the lab.
  • Additional data has been uploaded: you will need to return to review the updated case details.
  • Resolution is required: There is disagreement among the adjudicators about the determination. A conversation outside the tools will be required to resolve the case.

Update Determination

If you decide you need to change your determination before a case is closed, either because additional data was provided, or because you have reached a consensus in a resolution conversation after disagreeing determinations were reached, you may do so:

  • Return to the Case Determination tab and click Update next to the case.
  • Scroll to the bottom of the case review page.
  • Click Change Determination to open the adjudication determination page.
  • Review details as needed.
  • Click Change Determination to review your previous determination.
  • Change entries as appropriate and click Submit.

Related Topics

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