01
What is in it
The 164 DutyPath codes: each one names a stall — a missing referral number, a claim routed to the wrong processor, an attestation about to lapse, a payer-marked copay on a VA episode — and the action that clears it. The gateway table: Optum Serve and TriWest by region, VA FSC for agreements and emergencies, TRICARE East and West, CHAMPVA, Medicare and Medicaid, with the payer identifiers, the transactions each takes and the portal where status lives. The clocks: timely filing, reconsideration, corrected claims, per program. The routing of every adjustment reason code to a next action.
- 164 codes, each with the stall it names and the action that clears it.
- The federal payer gateway table, sourced to VA's routing page and the TPA handbooks.
- Filing, reconsideration and corrected-claim windows by program.
- Reason-code routing: which adjustments post, which become tasks, which never touch a patient.