Processing Low Income Health Care Card (LIC) claims 101-18042300

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.

Paper claims

When a Claim for a Health Care card (SS050) is scanned to the customer's record, a Social Application (SOA) shell work item is generated on the customer's record. If the customer has indicated on the paper claim that their partner will require a Health Care Card (HCC) of their own, create a SOA shell on the record by scanning the paper claim to both records. This has 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 documents.

Note: children in the care of Approved Care Organisations may qualify for a LIC in their own right as long as no individual is being paid FTB for the care of the child. The Claim for a Health Care Card (SS050) must be completed in the name of the child and not in the name of the organisation or a worker from that organisation.

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

Is the claim for a child in the care of an Approved Care Organisations?

• Yes, and the child:
• has a person (PER) CRN. Go to Step 2
• does not have a CRN. See Adding a customer to the system, then complete actions to move the digital image to correct CRN. Go to Step 2
• has an existing child (CHI) CRN. Convert the CHI record to a person (PER) record, then complete actions to move the digital image to correct CRN. Go to Step 2
• No, go to Step 2

Has the claim previously been rejected?

• Yes, to reassess a previously rejected claim:
• If rejected Failure to Supply Documents – FSD see Request to reassess a rejected claim
• To re-index the claim refer to 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

To review the claim summary:

• select to view the Claim Summary provided by the customer
• select to expand the Claim Summary in a new window if needed
• review the Claim Summary. Key details include:
• relationship status
• Australian residence
• income details
• select Documents to view the documents provided by the customer (uploaded online or scanned to their record)

Note: customer's identity must be confirmed. Identity Review periods are not applicable to LIC claims.

To view supporting documents, select:

• links at the bottom of the expanded Claim Summary, or
• , or
• the Documents icon

Check the date the document was scanned.

Have all relevant supporting documents been provided?

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

A customer identified as vulnerable as part of the Low Income Health Care Card (LIC) claim can submit their claim before completing all required tasks.

Does the claim have the keyword '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, the claim must be rejected. REJ the claim Failure to Supply Documents (FSD). 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 and not returned, the claim must be rejected. Procedure ends here

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

If the contact was successful record the details of the conversation in the Progress of Claim (POC) Note. If the customer:

• has provided required information to assess the claim verbally or the customer can immediately upload the information, go to Step 6
• if cannot immediately upload the information and it is still required:
• issue a request for any additional information. Select > Request Documents
• do not re-request documents that have previously been requested at Next Step of the claim. This process is only relevant where more information or evidence is required to clarify the customer’s circumstances to assess 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 for the customer to provide the information or evidence verbally:

• issue a request for information. Select > Request Documents
• record the details of the genuine attempts, including 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, the claim must be rejected. Procedure ends here

These details must be reviewed/updated before selecting Process.

On the TS screen:

• Link Summary (LS) table shows linked recorded, for example:
• Partner and any Relationship Qualifier Code
• Children
• Marital Status (MS) table shows the customer's relationship details. For help with coding, see Process Direct navigation, common screens and functions

Compare relationship details provided in the claim with the details already recorded in the Marital Status (MS) table. If the customer has given different information about their relationship in the claim, to the confirmed data in the MS table, make genuine attempts to contact the customer to confirm the correct relationship details and dates. If phone contact is unsuccessful the relationship details supplied in the claim should be applied.

Note: a Member of a couple (MoC) assessment is not required for a customer and sharer/other person who are claiming or have a current Low Income Health Care Card (LIC) only.

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

• select > Regenerate claim to regenerate the claim

Is the claim to be rejected, as the customer does not meet basic LIC qualification or streamline rejected?

• Yes, for:
• automatically rejected, see Step 1 in Table 3 to continue processing the claim
• streamline rejected, while the decision may already be made to Streamline Reject the claim, if the customer is current on a payment, staff need to ensure any change of circumstances declared within the claim is actioned. See Rejecting a claim for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC). Procedure ends here
• No, go to Step 8

Are further actions required?

• Yes:
• a referral is required, go to Step 9
• actioning a completed Assessment of Care Arrangement referral is required, see Step 4 in Table 2
• No, there are no outstanding referrals, see Step 1 in Table 3

If a specialist assessment is required:

• select > Referral
• complete the referral details
• if more than one referral is required, ensure that all referrals are completed
• after a referral is made, the claim remains on hold until the assessment has been completed. Annotate the Progress of Claim Note with details of the request
• when the referral is completed, continue processing the LIC claim

Unless it is clear the claim must be rejected because basic eligibility criteria has not been met, claims needing a CAO referral should not be finalised until the assessment has been completed.

If the customer’s financial circumstances are complex, for example, they include a trust or company, a CAO referral is needed to make sure the income and assets tests are met.

For referral instructions, see Identifying and making suitable referrals to the Complex Assessment Officer (CAO).

Note: only refer to CAO if all documents for the new claim are received.

See Coding Compensation and damages (MOD C) to request a clearance for referral instructions.

A non-government payment, or a payment made by a private organisation is not a foreign pension and should not be referred to CIS for coding.

If necessary, make sure all foreign pension documents are scanned to the customer record ‘s 'INT’OG' ensuring that no work item is created (scan to store). Translation of foreign pension documents is not needed before referring to CIS.

See Foreign pension coding for referral instructions.

A completed FA012 form must be lodged as part of a LIC claim where either of 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 a Details of your child’s care arrangements (FA012) form has been requested and returned as part of a LIC claim. The Resources page has a link to the form.

If an Assessment of Care Arrangement FA012 form been returned and referral is required, see Step 1 in Table 2

Go to Document List (DL).

Check the Notes screen, to confirm if a care assessment has been completed. One of the below titles may display (this is not an exhaustive list)

• 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

Has a care assessment 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
• hold the claim and annotate the Progress of claim Note with 'Claim held for 14 days pending Assessment of Care Arrangements’
• procedure ends here
• No, go to Step 3

Select > Referral.

On the Referral screen:

• Referral Type, select Assessment of Care Arrangements Referral > Next
• Referral Reason, select the appropriate referral reason
• Document Lists, select Details of your Child's Care Arrangements (FA012)
• in the What is required? field, add, ‘LIC 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 LIC claim, care assessment required. FA012 scanned to record’
• in the Have all necessary documents been provided? field, select Yes
• select Finish

Select the Status icon. The Status screen shows the claim has been placed on hold for 14 days.

Select the Notes icon. Annotate the LIC Claim Progress Note with, 'Claim held for 14 days pending Assessment of Care Arrangements'.

Procedure ends here.

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

If the assessment outcome is:

• a change to or confirmation of care arrangements for a child already in care or no change to existing care arrangements:
• select to complete a SAP refresh
• see 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 LIC claim, depending on the care assessment results.

If a new child is in the customer’s care:

• select > Regenerate Claim
• once the claim has been regenerated, the child should be listed under the Known Relationships
• select > Child
• check the Child in Care (CHC) screen has been coded
• see Step 1 in Table 3

If the child is not in the customer’s care:

• select > Regenerate Claim
• go to Known Relationships
• check the child is showing
• under the Claim Relationships table, change the status to ‘Not Required’
• see Step 1 in Table 3

Note: before selecting Process, ensure all outstanding referrals are completed. If not, place claim back on Hold for a further 14 days and annotate the POC Note.

Do not start coding before selecting Process as this will result in errors.

Select Process to view the Errors (SWE) screen.

Before coding any screens:

• select Assess to send the claim details to ISIS
• when the Entitlement (ELD) screen displays, select Back or key ‘SWE’ in the Super Key to return to the SWE screen
• complete the claim coding

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 have mandatory screens are pre-selected.

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

A flag will display against all screens that have provisional claim data. These may not need to be accessed to process the claim:

• select the screens to be checked 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.

The following system errors display when a LIC NCL has not been processed and is more than 10 months old:

• E244ZZ - Cannot backdate DOR of a LIC NCL for more than 10 months in the past
• E051LI - LIC NCL cannot be completed for this date of commencement
• E0031 - This date may not be more than one year in the past

Have any of these error messages presented?

• Yes, see Step 1 in Table 4 on the Customer First tab
• No, continue assessing the claim, go to Step 3

Check information provided in the claim (provisional data) is accurate and in line with any evidence that has been provided, see income and financial investments.

LIC start date defaults to the date of claim lodgement. In some circumstances, based on the information supplied by the customer, staff may need to make a decision on the LIC start date.

LIC entitlement is based on the customer's last 8 weeks of income from the LIC start date, see Low Income Health Care Card (LIC) income test. If a decision is made to change the defaulted start date, the income assessment period will need to be reassessed and evidence supplied.

The customer’s residence qualification will be automatically assessed based on the residence information recorded. See Residence assessment for adult customer claiming a Low Income Health Care Card (LIC), Foster Child Health Care Card (FST HCC) or Ex-Carer Allowance (child) Health Care Card (EHC).

Note: residence information must still be recorded if the claim will be rejected for any reason. If residence details are not recorded, the system will override any other rejection reason and the claim will reject for a residence related reason.

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 nominee information has not been incorrectly ended, for example, Public Trust nominees, see Adding or rejecting a nominee request
• check there is no historical coding of continuous income that needs to be ended, see Recording and correcting employment income details

Has the customer provided all required information?

• Yes:
• and the customer has asked for the start date of the LIC card to be backdated, go to Step 4
• otherwise, go to Step 6
• No:
• streamline reject the claim Fail to Supply Documents - FSD
• see Rejecting a claim for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC)
• procedure ends here

The start date of a LIC may be backdated to a particular date of medical service or treatment to cover:

• medical
• pharmaceutical, or
• other related expenses already incurred

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

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 the processing date.

If backdating to a date more than 40 weeks from the date of processing, refer to the Level 2 Policy Help Desk - Concessions via the Online query form to request a manual override when all evidence has been gathered. Record a DOC confirming evidence supplied and date claim is to be backdated.

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

• Yes, and the claim is to be backdated:
• less than 40 weeks from processing date, go to Step 5
• more than 40 weeks from processing date, refer to the Level 2 Policy Help Desk - Concessions to request a manual override. Go to Step 6 once response from Level 2 Policy has been provided
• No, the claim cannot be backdated, go to Step 6

Go to the LIC Start Date (LSD) screen and select Add.

Complete all required fields:

• Start date, key the backdated date
• Reason for backdating, key a valid reason code:
• MED - Medical services or treatment
• DEL - Delayed processing of claim
• ARO - ARO review of decisions (applies to the outcome of a review officer decision made either by a Subject Matter Expert or an Authorised Review Officer)
• select Assess
• when the Entitlement (ELD) screen displays, manually navigate to relevant screens to ensure all Event Date field entries align with the correct 8 week assessment period and the backdated start date recorded on the LSD screen
• select Save

Does the customer have a dependent child/ren in their care?

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

CHOC screen must be recorded for each child individually.

Go to the CHOC screen via the Super Key:

• if the dependent child/ren do not display Service Reason LIC, select Add
• update Start Date:
• for a new claim, the date will default based on the date of receipt of the claim and the child's birth date. For the LIC Income test to be applied correctly, it may be necessary to change the date to the child’s date of birth if the birth occurred in the 8 week assessment period. Future dates are not permitted
• for reassessments code the date of the event
• Child Name, select each relevant child separately
• Service Reason, Low Income Health Care Card
• Reason, Claim
• select Save

After coding the claim:

• select Assess
• the Errors (SWE) screen will list any validation errors to address
• once the Message Log is clear, select Assess
• the Entitlement (ELD) screen displays the outcome
• ensure the claim outcome is correct for the customer (and partner if applicable)

Is the claim to be rejected?

• Yes, see Rejecting a claim for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC). Procedure ends here
• No, the customer is eligible for LIC:
• select Finish
• review the Claim Outcome Note and ensure the Getting it Right (GIR) Minimum Standards are met
• if backdating include: the backdated grant date and the reason continuous eligibility was met from the revised grant date
• select Finalise
• select Finish. A box will confirm the claim has been successfully completed
• procedure ends here

Check the claim form to make sure it is fully completed and:

• date stamp the claim form and any supporting documents
• sight and record original identity documents
• scan the claim form and any supporting documents onto the customer's record

Note: customer and/or partner’s identity must be confirmed. Identity Review periods are not applicable to LIC claims.

If the customer has indicated on the paper claim that their partner will need a Health Care Card (HCC) of their own, create a Social Application (SOA) shell on the record by scanning the paper claim to both records.

Note: children in the care of Approved Care Organisations may qualify for a LIC in their own right as long as no individual is being paid FTB for the care of the child. The Claim for a Health Care Card (SS050) must be completed in the name of the child and not in the name of the organisation or a worker from that organisation.

Is the claim for a child in the care of an Approved Care Organisations?

• Yes, and the child:
• has a person (PER) CRN. Go to Step 2
• does not have a CRN, see Adding a customer to the system and complete actions to move the digital image to correct CRN. Go to Step 2
• has an existing child (CHI) CRN. Convert the CHI record to a person (PER) record and complete actions to move the digital image to correct CRN. Go to Step 2
• No, go to Step 2

Has the claim previously been rejected?

• Yes, to reassess a previously rejected claim:
• if rejected Fail to Supply Documents - FSD, see Request to reassess a rejected claim
• to re-index the claim, refer to directions for SAP online claims in Indexing, re-indexing and cancelling claim activities. Once claim is re-indexed, go to Step 3
• No, go to Step 3

Select Inbox from the left hand menu or the Inbox icon from the Customer First tool bar:

• select Ready for Work
• select the Customer's name from the Details assignment block (displayed as a hyperlink) or select Workspace from the left hand menu
• go to Customer Details (CRN/BP)
• under the Interactions History tab select the Claim ID
• select Review Claim from the top of the Claim detail screen
• keeping the Review Claim window open, clear the customer record in Customer First and open Customer Record

Note: if both members of the couple wish to claim then a new claim process will need to be actioned on each individual's record.

Check claim to make sure all required documents have been provided.

If the customer is not receiving an income support payment, check if they may be eligible (for example, JobSeeker Payment or Disability Support Pension). Issue relevant forms as appropriate.

Have all relevant supporting documents been provided?

• Yes, go to Step 6
• No:
• where additional documents are needed, go to Step 5
• where documents have been requested at the time of the claim or after and not returned, the claim must be rejected, see Step 2 in Table 3

If more details or clarification of claim or submitted documents are needed to determine the customer's eligibility, make genuine attempts to contact the customer.

If the contact is successful, record the details of the conversation in the Progress of Claim (POC) DOC, and the customer:

• has provided the required information to assess the claim verbally and/or the customer can immediately upload the information, go to Step 6
• cannot immediately upload the information and it is still required and/or it is not appropriate for the customer to provide information or evidence verbally:
• issue a request for information see Requesting information (CLK)
• 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 for the customer to provide the information or evidence verbally:

• request for information, see Requesting information (CLK)
• record the details of the genuine attempts, including what information is needed in the POC DOC

Procedure ends here.

Are further actions required?

• Yes:
• only an Assessment of Care Arrangements referral is required, see Step 1 in Table 2
• actioning a completed Assessment of Care Arrangement referral is required, see Step 5 in Table 2
• all other referrals, go to Step 7
• No, see Step 1 in Table 3

If more than one referral is required, ensure that all referrals are completed:

• after a referral is made, the claim remains on hold until the assessment has been completed. Annotate the Progress of Claim DOC with details of the request
• when referral is completed, continue with processing of LIC claim

A specialist referral may be required for customers with:

• complex financial circumstances. For example, this may include a trust or company that requires a specialist assessment to ensure the income and assets tests are met:
• to make a referral to a Complex Assessment Officer (CAO), ensure all documents for the new claim are received. See Identifying and making suitable referrals to the Complex Assessment Officer (CAO)
• unless it is clear the claim must be rejected as basic eligibility criteria has not been met, do not finalise claims needing a CAO referral until the assessment has been completed
• compensation payments:
• to make a referral for a Compensation Clearance request, see Coding Compensation and damages (MOD C) to request a clearance for referral instructions
• foreign pensions:
• to make a referral to a Centrelink International Services Officer (CIS), see Foreign pension coding
• do not make referrals to CIS for a non-government payment or a payment made by a private organisation as they are not a foreign pension
• check all foreign pension documents are scanned to the customer’s record as 'INT’OG' ensuring that no work item is created (scan to store). Translation of foreign pension documents is not needed before referring to CIS

A Details of your child's care arrangements form (FA012) must be requested from the customer if as part of a LIC claim either of the following is advised:

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

Use the Request for Information guided procedure, see Requesting information.

The Resources page has a link to the Details of your child's care arrangements form (FA012).

Returned and scanned FA012 forms are allocated to the Families Assessment area for assessment. Check Document Tools for an FAO12 scanned to the customer’s record.

Has a FA012 form been received?

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

If an Assessment of Care Arrangements (care assessment) has already been completed a DOC will be listed with one of the following titles (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

Has a care assessment been completed?

• Yes, go to Step 5
• No, go to Step 3

Hold the claim for a further 14 days.

Annotate Progress of Claim DOC to advise action taken, for example, 'Claim held for a further 14 days pending Assessment of Care Arrangements'.

Procedure ends here.

The time allowed to respond can be extended where there are special circumstances preventing the claimant from lodging the requested documents for the claim.

See Step 10 in Table 1 on the Customer First tab in Requesting information (CLK).

Procedure ends here until FA012 is returned.

Review the progress of claim DOC for key information to determine the correct assessment result for the LIC claim. This includes:

• child name
• date of birth (DOB), and
• care percentage details

If there is no change to care, and the DOC indicates a LIC card has recently been issued, the LIC claim must still be processed.

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

Once assessment complete, see Step 1 in Table 3.

Note: if both members of the couple wish to claim then a new claim process will need to be actioned on each individual's record.

Check claim to make sure all required documents have been provided.

If the customer is not receiving an income support payment, check if they may be eligible (for example, JobSeeker Payment or Disability Support Pension). Issue relevant forms as appropriate.

Have all relevant supporting documents been provided?

• Yes:
• and the customer has asked for the start date of the LIC card to be backdated, go to Step 3
• otherwise, go to Step 4
• No, go to Step 2

If the customer has failed to return formally requested documents on within 14 days, a decision to reject the LIC claim may be made at any time from that point.

For all LIC claims including paper claims, the Service Officer must make genuine attempts to contact the customer before rejecting the claim to advise of the decision. A final decision should be made within 28 days of claim registration.

See Rejecting a claim for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC).

Procedure ends here.

The start date of a LIC may be backdated to a particular date of medical service or treatment to cover:

• medical
• pharmaceutical, or
• other related expenses already incurred

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

The customer must meet LIC eligibility for the 8 week assessment period before the backdated start date and retain eligibility during the backdated period.

See Step 5 in Low Income Health Care Card (LIC) income test.

See Residence assessment for adult customer claiming a Low Income Health Care Card (LIC), Foster Child Health Care Card (FST HCC) or Ex-Carer Allowance (child) Health Care Card (EHC).

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 the processing date.

If backdating to a date more than 40 weeks from date of processing, refer to the Level 2 Policy Help Desk - Concessions via the Online query form to request a manual override when all evidence has been gathered. Record a DOC confirming evidence supplied and date claim is to be backdated.

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

Select the LSD screen

• Start Date, key the backdated date
• Reason, the reason for backdating a valid reason code must be keyed. Valid reason codes are:
• MED - Medical service or treatment
• DEL - Delayed processing of claim
• ARO - ARO review of decision (applies to the outcome of a review officer decision made either by a Subject Matter Expert or an Authorised Review Officer)

Index claim, add person (and partner/dependants) and/or update person data as appropriate. If the partner is also claiming a LIC on the same claim form, a new claim will need to be indexed for the partner. The correct marital status must be coded on the Marital Status (MS) screen. (for example, 'SIN'gle, 'MAR'ried', 'DEFacto', 'WIDowed') This will make sure the correct income limit is applied. Service Officers must not use the codes 'UNK' or 'NRE' on the MS screen, as this will result in an incorrect outcome for the customer.

Note: online claims lodged by authenticated customers will generally be auto indexed. Complete the claim once auto data load has occurred.

When a customer and partner have indicated they both wish to claim LIC:

• complete for customer and then conduct a second claim for the partner
• use the same Date of Receipt (DOR)

Key identity and Commencement of Identity and proof of arrival in Australia information (needed for proof of residence) via the Identity Confirmation Dashboard in Process Direct for the customer (and partner).

The customer’s identity must be confirmed. Identity Review periods are not applicable to LIC claims.

LIC start date defaults to the date of claim lodgement. In some circumstances, based on the information supplied by the customer, staff may need to make a decision on the LIC start date.

LIC entitlement is based on the customer's last 8 week of income from the LIC start date. If a decision is made to change the defaulted start date, the income assessment period will need to be reassessed. See Low Income Health Care Card (LIC) income test.

The customer's residence qualification will be automatically assessed based on the residence information recorded.

See Residence assessment for adult customer claiming a Low Income Health Care Card (LIC), Foster Child Health Care Card (FST HCC) or Ex-Carer Allowance (child) Health Care Card (EHC).

Note: residence information must still be recorded if the claim will be rejected for any reason. If residence details are not recorded, the system will override any other rejection reason and the claim will reject for a residence related reason.

Go to the Low Income Health Care Card Task Selection (LITS) screen and select each income item for the customer ('S'), partner ('P') or both ('B'):

• income from employment (ongoing, casual or one-off) is coded on Employment Income Paid Details (EAPP) screen and the method of coding depends on the type of customer. The MS screen coding is also important as the partner of a LIC claimant is classified as a dependant. Service Officers must not use the codes 'UNK' or 'NRE' as this will result in an incorrect outcome for the customer. See Low Income Health Care Card (LIC) income test for coding information
• financial investment or self-employment details for a customer receiving an income support payment, primary benefit rules apply. See Low Income Health Care Card (LIC) income test for coding information

Note: income from previous claims may duplicate and affect the LIC payability. Check before finalising the claim.

Lump sum leave payments and redundancy payments are recorded on the Income Maintenance Period (IMP) screen. See Low Income Health Care Card (LIC) income test for coding information. The effects of lump sum leave and redundancy payments are displayed on the LIC Income Maintenance Lump Sum (LIM) screen, which indicates details of income apportionment over 12 months.

The effects of lump sum compensation payments show on the LIC Compensation Lump Sum (LIL) screen, which indicates details of income apportionment over 12 months. This information transfers from the Compensation Claim Summary (CMCS) screen which is maintained by the Compensation team.

For LIC income limits, see Rates and Thresholds.

When a LIC new claim is being processed, an effect date equal to the start of the 8 week income period is defaulted to the EAPP screen. This does not mean the 8 week amount has to be recorded as an IMP. See Low Income Health Care Card (LIC) income test for coding information.

• Select CHILD on LITS screen to set up LIC qualified children for inclusion in the claim assessment
• Finalise the activity on the Assessment Results (AR) screen. The card will usually be sent to the customer's postal address and display the customer's residential address. However, if the customer has more than 1 address recorded on the system (for example, term) then they can nominate a preference as to which of these will be used for postal and/or display purposes
• Complete all related scanned images on the customer's record, see Viewing Centrelink customers' digital images

If the claim was rejected automatically or needs to be rejected manually, see Rejecting a claim for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC).

Income affecting LIC assessment is summarised on the LIC Assessment Summary (LIAS) screen.

Note: when granting a new LIC, check that the EPED for any existing payments has not been altered.

Before finalising the claim:

• Manually navigate to the LSD screen
• Check the Start Date field entry is correct
• Check there is no duplication of income

Manually navigate to relevant screens, for example, Employment Income Summary (EANS), Savings Summary (SVS) to correct all Event Date field entries to align with the corrected date recorded on the LSD screen.

Go to AR screen to confirm the correct outcome, then finalise the claim.

Create a Fast Note. Select Auto Text use Concession Cards > Claims > Low Income HCC (LIC) NCL Grant/Reject DOC

• correct grant date particulars including the revised grant date and reasons for backdating
• eligibility was checked and is continuous from grant date to LIC claim date they have remained in Australia during the period
• the income was not above threshold during the assessed period

LIC is automatically issued on the card carrier (SS357). No separate grant letter is sent.

Note: if the claim has been finalised in Customer First due to Level 2 Policy advice, navigate to Process Direct and update the claim Status to Completed.

Procedure ends here.

The following system errors display when a LIC NCL has not been processed and is more than 10 months old:

• E244ZZ - Cannot backdate DOR of a LIC NCL for more than 10 months in the past
• E051LI - LIC NCL cannot be completed for this date of commencement
• E0031 - This date may not be more than 1 year in the past

If these errors messages occur, update the LIC NCL Status to On Hold.

• Identify the correct LIC start date by checking the date of claim submission
• Make sure the customer meets eligibility and qualification criteria
• the income test for 8 weeks before the intended start date of the LIC claim
• Record details on a DOC
• the correct LIC start date
• the reason/s for backdating, and
• that eligibility has been confirmed

Refer to Level 2 Policy Helpdesk - Concessions requesting claim to be backdated.

Procedure ends here until Level 2 Policy response has been provided.