Foster Child Health Care Card (FST) 101-06020010

Locate the work item in Process Direct

Select the Work item to go to the Customer and Claim Information table on the Transaction Summary (TS) screen to review and process the customer's claim.

Claim transactions within Process Direct may be:

• a claim activity
• an online or Assisted Customer Claim (ACC) that contains provisional data
• a Social Online Application (SOA) shell created from a scanned claim form
• a manual SOA shell created by a Service Officer
• a reindexed claim

Paper claims

When a Claim for a Health Care Card (SS050) for a foster child is scanned to the customer's record, a Social Application (SOA) shell work item is generated on the customer's record. This contains no claim information apart from:

• the Customer Reference Number (CRN)
• personal detail, and
• receipt date

Claim information will need to be manually added into the work item using details from the scanned claim and documentation.

For information on how to access claims for processing, see Process Direct navigation, common screens and functions.

Has the claim previously been rejected?

• Yes, to reassess a previously rejected claim:
• if rejected FRC failed to supply documents, see Request to reassess a rejected claim
• to re-index the claim, see directions for SAP online claims in Indexing, re-indexing and cancelling claim activities. Once claim is reindexed, go to Step 3
• No, go to Step 3

Select:

• to view the claim summary provided by the customer
• to expand the Claim Summary in a new window when needed

Review the Claim summary. Key details include:

• relationship status
• Australian residence
• income details

To view supporting documents, select one of the following:

• links at the bottom of the expanded Claim Summary
• from the bottom of the open Process Direct window, or
• the Documents icon

Has all relevant supporting documentation been provided?

• Yes, go to Step 6
• No, go to Step 4

A customer identified as vulnerable as part of the FST can submit their claim before completing all required tasks.

Does the claim display URGVULN on the Keyword screen?

• Yes, and:
• only additional documents are now required, go to Step 5
• it has been less than the time allowed to respond since the claim lodgement. Hold the claim for the appropriate timeframe from the Claim Submission Date on the Status screen. On the Notes screen add or update the Claim Progress note for action taken. Procedure ends here
• it has been more than the time allowed to respond since claim lodgement, reject the claim FRC - failed to reply to correspondence. See Rejecting a Low Income Health Care Card (LIC) claim. Procedure ends here
• No:
• if additional documents are required, go to Step 5
• if documents have been requested at the time of claim or after an allowable time to return has passed, reject the claim FRC - failed to reply to correspondence. See Rejecting a Low Income Health Care Card (LIC) claim. Procedure ends here

If more details or clarification of the claim and/or submitted documents are needed to determine the customers eligibility make genuine attempts to contact the customer.

If contact was successful, record the details of the conversation in the Progress of claim note. If the customer:

• provided all information to assess the claim verbally or they can immediately upload the information go to Step 6
• has not provided all information and cannot do so immediately:
• issue a request for information by selecting > Request Documents
• do not re-request documents that have previously been requested at Next Step of the claim
• tell the customer the claim may be rejected if they do not provide the required evidence. The claim will be placed on hold to allow customer to respond. Procedure ends here

If the contact was unsuccessful or it is not appropriate to provide the information or evidence verbally:

• issue a request for information by selecting > Request Documents
• record the details of the genuine attempts, also record what information is needed, in the Progress of Claim note. Note: documents that have been requested at Next Step in the claim must not be requested again. Reject the claim, see Rejecting a Low Income Health Care Card (LIC) claim
• procedure ends here

These details must be reviewed/updated before selecting Process.

View Relationship details on the Transaction Summary (TS) screen. For example, the Link Summary (LS) table shows linked records for:

• Partner and any Relationship Qualifier Code
• Children

For help with coding, see Process Direct navigation, common screens and functions.

Where updates have been made to relationship details, the claim will need to be regenerated:

• select > Regenerate claim

If the customer is already in receipt of FST for another child/ren or for the child/ren they have claimed for, this will display under the Concession dependant summary.

Go to the MCCS screen:

• under Concessions dependant summary, identify any children that have a Yes displayed under the Foster Child (FST) eligibility indicator
• select the twisty that corresponds to the child/ren displaying a Yes
• check the Concession dependant details. If the Concession source displays Foster card, with no Period end date, the customer is already in receipt of FST. Process any additional FST claims in Customer First

The care assessment will determine the customer’s qualification. Check the following details within the claim match the information held on the customer’s record for each child listed within the claim:

• Child in care
• Child no longer in care
• Percentage of care
• Principal care status

In Process Direct:

• go to
• select each relevant child from the right hand column
• go to the Shared Care Assessment (SCA) screen
• go to the Child in Care (CHC) screen

If a change is notified to care assessment information for any child listed within the claim:

• a care assessment and/or principal carer determination is required when one of the following applies:
• there is a change in the percentage of shared care
• the care is disputed or disagreed, or
• a child other than a newborn has come into the customer's care
• updates will be required when processing the claim via the Child task selector when:
• a child has left care, or
• a reduction in the percentage of care for a child. If the reduction of care is not confirmed, code the reduction as a preliminary decision

Evidence of formal or informal change of care must be lodged as part of the FST claim where the following is advised:

• a change to care arrangements for an existing child, or
• a new child has entered the customer's care

An Assessment of Care Arrangements referral must be created when evidence of care has been requested as part of the new claim.

If evidence of care has been returned, and:

• a referral is required, see Step 1 in Table 2
• action to complete the referral is required, see Step 5 in Table 2

Otherwise, go to Step 10.

An Assessment of Care Arrangement referral is not required and the:

• customer is already current on FST for:
• another child/ren, see Step 1 in Table 4
• the claiming child/ren, see Step 1 in Table 5
• FST is to be processed in Process Direct, see Step 1 in Table 3

Go to Document List (DL) refer to Notes to confirm a care assessment has already been completed. One of the below titles may display (this is not an exhaustive listing):

• Change in Care Status
• Changes in Child - No Decision Shared Care Decision
• Add child coming into care
• Care Decision
• Care details update per Child Support Agency (CSA), or
• Care assessment not required

Does a Note display with a date after the claim submission indicating a care assessment has been completed?

• Yes, go to Step 4
• No, go to Step 2

On the Notes screen, does a Note with the title 'Care Assessment referral' display with a date after the claim submission?

• Yes, the care assessment is in progress:
• place the claim on hold for a further 14 days, hold reason: Assessment of Care Arrangement Referrals. Annotate the FST Claim Progress note with 'Claim held pending Assessment of Care Arrangements'
• procedure ends here
• No, go to Step 3

To create a referral, select > Referral.

On the Referral landing page, select:

• Referral Type > Assessment of Care Arrangements Referral > Next
• Referral Reason, select the appropriate referral reason
• Document Lists, select Details of your Child's Care Arrangements (FA012) if the FA012 has been provided, otherwise leave this field blank
• in the What is Required? field, add these details:
• FST claim lodged DD/MM/YYYY. Care determination and Principal Carer determination is required for:
• child/ren's name and date of birth:
• new Child advised within FST claim, care assessment required. FA012 and/or Evidence of formal or informal change of care scanned to record
• for Have all necessary documents been provided?, select Yes
• select Finish
• select the Status icon. The Status screen will now show the claim has been placed on hold for 14 days
• select the Notes icon
• annotate the FST Claim Progress note with 'Claim held for 14 days pending Assessment of Care Arrangements and any further action taken'

Procedure ends here.

Review the Notes for key information to determine the assessment result for the child/children in the FST claim. This includes child name, date of birth (DOB) and care percentage details.

Does the assessment outcome reflect:

• a current FST Customer is claiming for an additional foster child/ren, see Step 1 in Table 4
• a change to or confirmation of care arrangements for a child already in care or no change to existing care arrangements:
• select SAP Refresh
• go to Step 1 in Table 3
• a new child has entered the customer's care, go to Step 5
• the child is not in the customer's care, go to Step 6

Note: use the steps above to apply different circumstances to each child where there is more than one child listed within the FST claim, depending on the care assessment results.

Select > Regenerate Claim.

Once the claim has been regenerated, the child should be listed under the Known Relationships

Select the child from and ensure the Child in Care (CHC) screen has been coded.

See Step 1 in Table 3.

Select > Regenerate Claim.

Open the Known Relationships and check if the child is showing.

As the child is not in the customer’s care, the claim will automatically reject. Record all information provided on the claim by selecting the Task Selectors and updating the fields.

See Step 1 in Table 3.

Select Process at bottom right to start processing. Do not start coding before selecting Process. This will result in errors.

The Errors (SWE) screen will display.

Before coding any screens:

• select Assess to send the claim details to ISIS
• the Entitlement (ELD) screen will display
• return to the SWE screen to complete the claim coding. Select Back or key SWE in the SuperKey

Message Log

This section displays any errors with existing coding. These must be fixed before the claim can be assessed. For help, see Using Digital Assistant Roxy in Process Direct.

Task Selectors

These list common screens. Task selectors that contain mandatory screens are pre-selected.

Task selectors may not list all screens that need to be checked or coded. Check screens to compare historical details with the claim details.

A flag displays against listed screens that contain provisional claim data. These may not need to be accessed to process the claim:

• select screens to be checked and/or updated. There is an option to select all screens
• select Next or press [Enter] to go through the selected screens
• use Super Key to go to screens. Key 'screens' to view a full list

Select all relevant Task Selectors and select Next:

• key/update required information for each relevant screen
• check information provided in the claim (provisional data) is accurate and in line with any evidence that has been provided. Update where necessary
• check there is no conflict between the provisional data and confirmed data. Correct where necessary
• check nominee information has not been incorrectly ended, for example, Public Trust nominees

Has the customer provided all required information?

• Yes:
• and the customer asked for the start date of the FST card to be backdated, go to Step 3
• otherwise, go to Step 5
• No, streamline reject the claim as FRC - failed to reply to correspondence. Procedure ends here

To cover medical, pharmaceutical or other related expenses already incurred, the start date of the FST may be backdated to a particular date of medical service or treatment given to the foster child.

The customer must provide evidence of the medical service or treatment to support the request for backdating the start date with the new claim.

Claims may only be backdated for a period in which eligibility is satisfied. As the card is for the child, the claim may cover a period during which the child lived with 2 or more carers.

If eligibility is broken during the period, for example, the child returned to live with their parent, the single claim covers all periods. Each period needs to be processed separately and letters will be issued for each claim period. Ensure contact is made with the customer to advise of multiple advise and clearly document.

To backdate the start date for FST, the Date of Receipt (DOR) for the claim activity must equal the date of medical service or treatment and must not be more than 40 weeks earlier than today's date.

The start date field on the LIC Start Date (LSD) screen defaults to the DOR. This date may be changed during a new claim activity and can be no earlier than 40 weeks before today's date.

Has the customer provided evidence and requested the start date to be backdated?

• Yes. If the claim is to be backdated:
• less than 40 weeks from processing date, go to Step 4
• more than 40 weeks from processing date, refer to the Level 2 Policy Help Desk - Concessions to request a manual override. Go to Step 5 once response from Level 2 Policy has been provided
• No, the claim cannot be backdated, go to Step 5

Go to the LSD screen and select Add.

Complete all required fields:

• Start date, key the backdated date
• Reason for backdating, key a valid reason code
• select Assess
• when the Entitlement Results (ELD) screen displays, manually navigate to all relevant screens to ensure all Event Date field entries align with the backdated start date keyed on the LSD screen
• select Save
• select Assess

CHOC screen must be recorded for each child individually:

• go to the CHOC screen
• if foster child does not display Service Reason FST, select Add New
• update Start Date:
• for claims, the date will default based on the date of receipt of the claim and the child's birth date, update to the date the child became a foster care child of the carer. Future dates are not permitted
• Child Name, select each relevant child separately
• Service Reason, Foster Child Concession Card
• Reason, Claim
• select Save

Use the Child Miscellaneous (CHM) screen to record foster details for each child/ren. When the Foster Child field is selected the child will automatically be assessed for FST.

• CHM will need to be coded for each child individually
• go to the CHM screen
• under Natural/Foster child details, if foster child does not display Principal Carer Type FSF or FOS, select Add
• Child CRN, relevant child
• Event Date, key the date the child became a foster child of the carer
• Foster Child FAO, Yes
• Principal Carer Type, Foster Parent (Informal) or (Formal)
• select Save

If the customer is:

• a Family Tax Benefit (FTB) recipient, and
• an FTB-eligible child is recorded as a foster child on the CHM screen, and
• the customer is not eligible for an auto FTB HCC

The child will be automatically assessed as entitled to FST.

Ensure all residency coding has been updated for the child/ren.

To activate datalink, see Activating the Department of Home Affairs datalink and contingency procedures if datalink is unavailable.

After coding the claim and addressing the data validations:

• select Assess
• the Errors (SWE) screen will list any validation errors to address
• once the Message Log is clear, select Assess
• when the Entitlement (ELD) screen displays, ensure the outcome is correct for the customer and/or partner
• select Finish
• review the Claim Outcome DOC and ensure the Getting it Right (GIR) Minimum Standards are met
• select Finalise
• select Finish. A box will confirm the claim has been successfully completed

Procedure ends here.

Where the customer lodges a new claim for an additional foster child and the customer is already FST current, the child coding needs to be completed outside of the new claim.

In Customer First:

• key the customer's CRN in the CRN/BP field > [Enter]
• the benefit Status line will display with FST/NCL
• go to Concession Card Details (CCIS) screen to confirm which child/ren already have current entitlement to FST
• go to the Child Selection (CHS) screen. If the foster child is not showing, see Linking a child to a customer's record

Select the foster child requiring FST from CHS. When the Child Task Selection (CHTS) screen displays, select the following:

• In Customer Care
• Miscellaneous Circ
• Override/Claim
• Student/Inc Circs

Update the Source and DOR field with the date the child's FST’s eligibility commenced.

Continue the screen flow and complete all other required fields:

• Child in Customer Care (CHC) screen, ensure the following has been keyed correctly:
• the date that the child entered the customer's care in Event Date field
• ICC in Care Status field if the child is in the customer’s care
• Child Student/Income Circumstances (CHSI) screen, key an appropriate entry in the Student Code field to ensure that the system can determine if the child meets the FTB age related requirements and rejects the claim if appropriate
• Child Miscellaneous Circumstance (CHM) screen, in these fields:
• Event Date, key the eligibility start date
• Foster Child FAO, key Yes
• Principal Carer type, key FSF Foster Parent Formal, or FOS - Foster Parent Informal
• Child Override/Claim (CHOC) screen, in these fields:
• Date, key the eligibility start date
• Svc Rsn, key FST
• Reason, key Clm
• go to the Child Immigration Enquiry (CHIMME) screen:
• request an Immigration Datalink
• update all known details
• go to the AR screen and select Finalise
• go to the Concession Benefit Action (MCBA) screen and complete a refresh (RSH) with the Effect Date as the date of claim
• go to the CCIS screen to confirm FST has updated for the additional child

Key and complete details in the Foster Child HCC (FST) NCL Grant/Reject Fast Note.

The additional child claim will need to be updated to Completed.

Go to Process Direct to finalise the FST SOA:

• select Inbox tile
• key the Customer CRN, select Go
• select the Foster Child Health Care Card claim Work Item with the corresponding Claim ID
• select the Status icon
• select the Change Status icon
• update the Status field to Completed
• select Save

Procedure ends here.

A duplicate claim is where the customer has lodged the FST claim for a foster child and then lodges a subsequent claim for the same child.

Where the customer has lodged a duplicate claim, update the duplicate claim to Not Required.

Go to Process Direct to finalise the FST SOA:

• select Inbox tile
• key the Customer’s CRN, select Go
• select the Foster Child Health Care Card claim Work Item, with the corresponding Claim ID
• select the Status icon
• select the Change Status icon
• update the Status field to Not Required
• select Save

Procedure ends here.

If the customer wants to cancel their FST, discuss the decision with the customer before finalising the cancellation action.

To cancel the FST, go to the Benefit Action (BA) screen. In these fields:

• Nxt, key BA
• Sys, key LIC

Complete these fields:

• Svc Rsn, key FST
• Action, key CAN
• Reason, use field help ('?') to view the appropriate codes or see Cancellation and rejection codes for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC)
• Effect Date, key today's date
• Notes, key notes
• Source, key source
• DOR, key the date of receipt

Finalise activity via the Assessment Results (AR) screen.

Record all relevant details of the cancellation in a closed DOC. Clearly document the conversation with the customer and the reason they wish to cancel their FST, following the Getting It Right DOC minimum standards.

Note: an act reference is not required when customer is requesting cancellation, and the Reason field has been coded with 'CLR' withdrawn/voluntary surrender.

Procedure ends here.