ESI claims issues – common pitfalls

Sep 17, 2021

A few tips on how to avoid the most common issues that can cause payment delays!

  • Full and complete audit trails must be provided within 12 working days of submitting a claim to avoid delays in verification and payment. Beneficiaries that consistently don’t provide full audit trails will revert back to quarterly claims and payment will only be made after the Monitoring and Verification Team (MVT) checks have been completed.  Be organised!
  • Remember that there are naming convention rules when uploading documents so that MVT staff can easily identify the relevant documents. It’s also important to upload documents to the relevant review folder which will be named in your sample e-mail from MVT.
  • MVT are in the process of closing all outstanding ‘temporary ineligible’ items that were introduced at the height of the pandemic. Where evidence cannot be provided for items that are still temporarily ineligible, transactions will be made permanently ineligible.  The temporary ineligible process will now only be used for exceptional circumstances.
  • Plan ahead for closure. Provide the necessary evidence for outstanding issues or irregularities so that they can be closed ahead of the final claim stage. Leaving old issues and irregularities to the final claim can be very problematic and may lead to a delay in payment.
  • Be aware of the risk of procurement breaches as a result of modifications to contracts. Modifications need to be in line with regulation 72 of the Public Contracts Regulations (PCR), and any price increases must not exceed 50% of the original contract value.  Corrections may be applicable for any spend over the 150%.

Read the WEFO COVID-19 Conditions for Support and FAQ’s guidance.