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DECISION DESK TEMPLATE
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AGENT
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Agent’s Name
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JOB NUMBER
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Service Job Number
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CONTRACT
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What type of contract (HMS, P3, etc.)
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CONTRACT NUMBER & START DATE
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Contract Number and the Effective Date
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STATE
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What state is customer in
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CA/IA/SAMS
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Is customer in CA/IA, or is this a Sam's Club HVAC
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PART(S) FAILED
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What part/parts have failed
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REASON FOR FAILURE
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Why did the part/parts fail
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SUPPORTING EVIDENCE
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What is the supporting evidence for the denial
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AGENT COMMENTS
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Any comments from the agent
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CONTRACT CITATION
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Where is denial located in contract and what is verbiage
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ADDITIONAL NOTES
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Any additional notes
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FULL/PARTIAL
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Is this a full or partial denial
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Example

Add spaces between each section to make it easier to see each section in detail.
Agent: Justin Petronico
Job Number: SCCS8416B2AA-1
Contract: HMS
Contract Number & Start Date: 10740560.5 and 03/15/2024
State: MD
CA/IA/Sams: No
Part(s) Failed: Gas line outside of home
Reason for Failure: Leaking
Supporting Evidence: No optional outside gas line coverage
Agent Comments: Gas line leaking outside the home
Contract Citation: VI.3 “located outside the perimeter of the main foundation”
Additional Notes: n/a
Full/Partial: Full
Customer Service Note
In an effort to help Customer Service better relay denial information to the customer, the following note has been added after the Decision Desk Note.

This will not be used for CA/IA or Sam’s Club HVAC denials.
Example
***CUSTOMER SERVICE NOTE***
SP called in to give a diagnosis on your gas line
Per section VI.3 of your contract:
Located outside the perimeter of the main foundation is not addressed
To see the details of coverage related to this claim in your service agreement, please log into MyAccount.
***END OF CUSTOMER SERVICE NOTE***