Complex Assessment Officers (CAO) 101-05070000

CAO assessment can be requested for:

• new claims processed using Process Direct and non-new claim referrals in Process Direct via Referrals
• other claims and non-new claim referrals in Customer First using CAO Referral guided procedure
• escalations via CAO Fast Note

For instructions on CAO referrals and escalations, see Identifying and making suitable referrals to the CAO.

Immediate priority processing

If immediate priority processing criteria are met, an escalation can be sent after a CAO referral has been made.

Asset hardship

For reassessments of a payment under the asset hardship provisions, see Assessment of assets hardship. Staff must contact the Assets Hardship team before making a CAO referral.

CAO work items are allocated via 'ready for work' in either Customer First, Work Optimiser or Process Direct.

To view details of the referral for:

• New claim referrals created in Process Direct:
• open Customer First
• key in the CRN > [Enter]
• select the CRN/BP hyperlink > Activities tab
• locate the CAO referral work item and select the referral ID hyperlink
• select the Notes tab > Text hyperlink to view all notes
• Non-new claim referrals created in Process Direct:
• open Process Direct and select Customer Summary
• key the CRN and select Go or [Enter]
• select the customer’s name to display the record
• select the Transactions icon > All transactions
• select the referral identification number link for CAO referral in the list
• when the Referral landing page screen shows, select Next at the bottom of the screen to view the notes on the CAO Referral page
• Referrals created in Customer First:
• view Notes on the DL screen in Customer First
• Escalations via Fast Note are to be closed after an existing or a new CAO referral work item (activity or DOC) has been created or allocated to the CAO. If the customer’s circumstances do not meet the escalation criteria, CAOs must:
• check to see if there is a related CAO referral or,
• create a CAO New Claim referral. If creating a referral, use the date of the priority processing request as the date of receipt (DOR) and include details of this instruction
• leave the CAO referral open
• send feedback using the Staff Feedback Tool
• close the escalation Fast Note
• unassign any bundled CAO work items using reason second contact required
• Level 2 Complaint and Ministerial request Fast Notes
• CAOs must action these requests in line with Fast Note - processing Escalated, External and MPASCO Complaint Fast Notes (CLK) in the Complaints and feedback index

Is the CAO referral for a valid CAO assessment reason and needs a CAO assessment?

• Yes, go to Step 3
• No, go to Step 10

Only one CAO referral is required, including for partnered customers.

Check Work Optimiser for duplicate referrals:

• select Worklist
• change My Work to Customer Search
• key the customer’s CRN into Customer ID

Is there a duplicate CAO referral in Work Optimiser?

• Yes, duplicate referrals to be cancelled or closed before continuing, see Table 2
• No, go to Step 4

Note: this does not apply where the new claims process was selected in a referral for current customers with new trust/company involvement or LIC renewal.

Was the CAO assessment requested for a new claim and the new claim has since been withdrawn or rejected?

• Yes, and:
• there are no other outstanding claims for the customer and/or partner, go to Step 10
• the customer/partner has lodged multiple claims where at least one other claim is In Process/On Hold and will require a CAO assessment, go to Step 5
• No, go to Step 5

Has all the information and documents needed to complete the CAO assessment been provided?

• Yes, go to Step 11
• No, go to Step 6

If scanned documents are indicated in the referral, wait until they are available before calling the customer.

If the documents are not available within 2 working days, make genuine attempts to contact the customer by phone to clarify what has been lodged. Send a pre-call notification SMS if the customer is subscribed to electronic messaging. See Calling a customer or returning a customer’s call.

If the contact is unsuccessful, annotate the Process of Claim Note/DOC or the CAO referral DOC recording all contact attempts.

Could the customer be contacted?

• Yes, go to Step 7
• No, go to Step 8

Confirm the referral reason and documentation requirements:

• if additional supporting documents are needed, request information and documents
• get third party contact details and authority to contact third party as needed. If necessary, ask the customer to tell the third party we may contact
• tell the customer:
• the due date for the return of information and documents
• their claim will be rejected if not provided by the due date
• if a letter will be sent to formally request the additional documents
• annotate the Progress of claim Note/DOC or the CAO referral DOC to record the phone conversation:
• record details of the phone conversation with customer and or/third party
• if a letter is issued, record date issued and the due date for the return of information and documents
• if verbal request for information was completed, record details and the due date for the return of information and documents

Go to Step 8.

The customer must be told if additional information or documents are needed. This includes when a third party (for example, accountant) has been contacted for information and/or documents.

Request further information/documents from the customer using the most appropriate channel. See Requesting information (CLK):

• verbal request
• issuing Request for Information (RFI) guided procedure
• QSS32 or XOBS32 (customers outside Australia) letter

Note: for Aged Care Means Test assessments use the templates located on the Resources page of Aged care letters - creating manual letters.

Where a customer has requested the CAO obtain documents through a third party, this may be considered express or implied consent providing the CAO with the authority to contact the third party. See Implied consent regarding third parties for more information.

Contact with third parties is by telephone only.

Document the record with details of the request i.e. annotate the Progress of claim Note/DOC or CAO referral DOC with details of the request. For example:

• verbal request for information
• request for information sent, asking for [insert details]
• customer advised accountant's details as [insert details]
• unable to contact customer [include phone number(s), date and time(s) of contact attempts]

Place the activity on hold and allow extra time for mail delivery.

Go to Step 9.

Have all the information and documents needed to complete the CAO assessment been provided?

• Yes, go to Step 11
• No, go to Step 10

A CAO assessment is not to be completed where:

• a new claim has been withdrawn or rejected
• the request does not meet the CAO assessment guidelines

If an inappropriate CAO referral has been created, send feedback using the Staff Feedback Tool.

A CAO assessment is unable to be completed where:

• insufficient details have been provided to complete the assessment, and
• the customer fails to respond to a request for information

The CAO must make genuine attempts to contact the customer by phone prior to suspending payments. Each attempted phone call must be recorded on a DOC.

When the payments are suspended FRC the CAO must hold the CAO referral for 14 days. On day 15 if the customer is yet to provide outstanding correspondence the referral can be closed.

Note: CAOs must not use the suspension code FRT for manual suspension, this code is an automatic code where customers fail to respond to TAC annual review letters. See Program, discretion and estimate reviews and reminders for private trusts and private companies.

Go to Step 14.

Consider adverse customer outcomes before completing the CAO assessment

Decide if the CAO assessment will be the major factor in any adverse decision that affects the customer's payment. If it is, the CAO must make genuine attempts to contact the customer by phone. See Advising verbally of an unfavourable decision.

If the contact is unsuccessful, annotate the Progress of claim Note/DOC or the CAO referral DOC recording all contact attempts.

Go to Step 12.

Complete any required system coding for the CAO assessment, if applicable. Refer to the relevant Operational Blueprints for each assessment type.

Go to Step 13.

For a private trust, private company, or special disability trust assessment

DOC the full details of the CAO entity assessment on each entity record using the appropriate CAO assessment Fast Note. This is the only DOC recorded on an entity record.

For other CAO assessments

DOC the full details of the CAO assessment on each customer record using the appropriate CAO assessment Fast Note.

See Resources Table 1 for the list of Fast Note templates.

Go to Step 14.

DOC a summary of all CAO assessments on all customer records related to the assessment and linked to the entity. Use Fast Note - select Auto text, use either:

• Complex Assessment > CAO Use Only > CAO Assessment Completed
• Complex Assessment > CAO Use Only > FHA CAO Assessment Completed

HEAS/Asset Hardship assessments should use Fast Notes as directed by the relevant Operational Blueprints.

Do not record the Assessment Completed or FHA CAO Assessment Completed DOC on an entity record.

The 'subject line' for the CAO DOC must be CAO Assessment so it is easy for processing staff to identify.

Include the appropriate additional service officer information/actions in the Fast Note.

See Resources Table 2 for the Fast Note text options.

Record if the CAO was unable to make an assessment because the customer has not provided the requested information. Include details of the outstanding information.

Finalise the CAO Assessment DOC by selecting Completed.

Go to Step 15.

In Process Direct:

• edit the Referral Details assignment block to update the status to Completed

• select Save to finalise the changes

In Customer First:

• Finalise the CAO referral activity by selecting from the Activity List (AL) screen and completing the started DOC

Note: if a process requires a specific work allocation action, follow the instructions provided.

Is there a claim/activity related to the referral on record (Customer First, Customer Record or Process Direct)?

• Yes, go to Step 16

• No, go to Step 17

In Process Direct:

When the CAO referral work item is set to Completed, the claim or reassessment activity status should automatically change from On Hold to In Process where there are no other referrals with a Status of In Process.

Confirm the activity status:

• Select Customer Summary from the Process Direct Landing page
• On the Search Criteria screen:
• key the CRN and select Go
• select the customer’s record from the Search Results table
• In the record, select the Transactions icon > All transactions
• If the relevant claim or reassessment transaction status has not automatically changed to In Process, check if there are any other referrals still In Process.
• If there are none, select the claim or reassessment hyperlink:
• select Status icon
• select Edit
• use the dropdown to update the status to In Process
• select Save
• If immediate new claim and non-new claim priority processing criteria are met, follow the processes to escalate

In Customer First or Customer Record:

• For activities (including claims), manually take the associated activity off hold on the Activity List (AL) screen
• If the customer's partner also has a claim held for the same referral reason, make sure the partner's claim Status is no longer On Hold
• If immediate new claim and non-new claim priority processing criteria are met, follow the processes to escalate

Note: taking the activity off hold will result in it being allocated, based on previously established priorities. The user logon on this activity does not impact work allocation.

Go to Step 17

More action is required in the following circumstances:

If more action is needed and no activity about the referral is on record (Customer First, Customer Record or Process Direct), create an open work item:

• use Fast Note - select Auto Text using either:
• Complex Assessment > New Claim > CAO requests SO action for New Claim
• Complex Assessment > UPD > CAO requests SO action for Reassessment
• insert date CAO assessment completed and claim type or service reason
• select Confirm
• add keyword to the activity for claim type/service reason
• ACTABY - ABSTUDY
• ACTAGE - Age Pension
• ACTAUS - Austudy/Youth Allowance (Student)
• ACTCAR - Carer Payment
• ACTDSP - Disability Support Pension
• ACTFHA - Farm Household Allowance
• ACTJSP - JobSeeker
• ACTLIC - Low Income Health Care Card
• ACTPPP - Parenting Payment Partnered
• ACTPPS - Parenting Payment Single
• ACTRCA - Aged care means assessment
• ACTSPB - Special Benefit
• ACTYAL - Youth Allowance (JobSeeker)

Note: the claim type/service reason keyword must be added at the time the Fast Note hand off is created. If this is not done, an Unfinalised Activity - Immediate Action required work item will appear in the Inbox. If this happens, complete the original Fast Note, then re-create the hand-off in line with the process above.

Procedure ends here.

Place a Display on Access (DOA) DOC on the record if the customer was receiving income support payment or a Low Income Health Care Card:

• granted before a CAO assessment, and
• has since been cancelled, and
• has not provided the documents needed, and
• all reasonable attempts have been made to contact the ex-recipient to request the information needed

Use Fast Note > Complex Assessment > New Claim > CAO Assessment unable to be completed:

• DOA Code: NSE Non-standard earning assessment
• Expiry Date: leave blank
• Transfer to Region: CAO
• Keywords: CAOCAN
• Extra Details: CAO Assessment Incomplete:
• Complex Assessment Officer (CAO) assessment unable to be completed for (PAYMENT TYPE) claim period xx/xx/xxxx – xx/xx/xxxx
• Payments cancelled before CAO assessment and customer failed to reply to CAO request for information
• If the customer claims an income support payment or a Low Income Health Care Card, continue new claim process including any required CAO referrals as per business as usual requirements
• Do not close the DOA DOC until the action needed for past claim period has been determined

Procedure ends here.

Forward the CRN by email to Business Process CAO, where:

• the customer claims an income support payment or a Low Income Health Care Card
• an annual review is due for the DOA DOC

Business Process will escalate reported cases to the payments type programme team.

Procedure ends here.

If more than one CAO referral has been created:

• copy the referral description notes of the most recent referral, including the date and time. Annotate the oldest referral with the details
• cancel or close the newest referral, ensure the oldest referral remains open

If the customer’s activity (including new claims) status is set as Open place the activity On Hold for 42 days whilst the CAO assessment is pending.

If the CAO referrals were generated on the same date in Process Direct and another system, keep the Process Direct referral.

To see where the referral was made, check the Work Item ID in Work Optimiser:

• Work items created in Process Direct start with a zero '0'
• Work items created in Customer First/Customer Record start with the Customer Reference Number (CRN)

Is a duplicate referral created in Process Direct being closed?

• Yes, go to Step 2
• No:
• cancel or close the newest referral from the Activity List (AL) screen in Customer First/Customer record
• ensure the oldest referral remains
• procedure ends here

Remove the CAO referral via Customer First:

• select the CRN/BP hyperlink next to the customer's CRN
• select the Interaction History or Activities tab to show outstanding activities
• locate the CAO Work Item and select the blue Work Item ID to open the work item
• select the newest referral, ensure the oldest referral remains > Edit
• select the Status drop down box > Not required > Save

If the customer’s activity (including new claims) status is set as Open place the activity On Hold for 42 days whilst the CAO assessment is pending.

Procedure ends here.