During a case discussion

During a case discussion, a specialist advisor may be able to provide additional information to facilitate further questions that a case manager may have about a review to help them make a determination.

Practitioners will be able to support case managers explore the gaps and inconsistencies of a review. By sharing their expert knowledge, they can help case managers identify whether the information shared in the review is what would be expected for that individual given their condition and circumstances. This will also help case managers determine whether supporting information is needed for reviews that are submitted without supporting information.

Case managers should not automatically request a case discussion for reviews without supporting information. A case discussion with a practitioner should only be requested on the grounds of gaps and inconsistencies where the case manager has already identified these. A case discussion with a practitioner may identify more gaps and inconsistencies but it is not for the practitioner to make the initial decision that there is an apparent gap and inconsistency.

Where a case manager decides that supporting information is needed, practitioners will be able to suggest sources of information that are likely to exist which may support an individual’s review. A case manager will be able to ask additional clarifying questions throughout a case discussion. Operational Guidance sets out how this is done.