Processing Low Income Health Care Card (LIC) claims 101-18042300
Low Income Claims (LIC) claims should be processed in Process Direct. Only process in Customer First, in limited circumstances, when directed.
On this page:
Assessment of Care Arrangements referral
Index and process a LIC claim in Customer First
Pre-claim processing
Table 1
Action | |
Customer contacts or work item allocatedIf the customer's query is about:
Note: when Service Officers get error E082CU - This service reason currently exists for this record when trying to run (ACC) for the customer to claim or renew LIC, go to Table 4 | |
Locate claimLocate 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 LIC of their own, scan the claim onto both records. This will also create a Social Application (SOA) shell on the partners record. For further information, see Table 3 > Step 2 in Indexing, reindexing and cancelling claim activities. This SOA shell will have no claim information apart from:
Claim information will need to be manually added into the SOA claim, using details from the scanned claim and documents. Note: children in the care of an Approved Care Organisations may qualify for a LIC in their own right, as long as no individual is being paid Family Tax Benefit (FTB) for 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 Organisation?
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Claim statusThe claim status must be In Process before it can be processed. If this claim has been submitted within 13 weeks of a previously rejected claim, see Request to reassess a rejected claim. If the previously rejected claim was able to be reassessed, the subsequent claim status should be updated to 'Not Required'. Is the new or reindexed claim status In Process?
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Review Claim SummaryTo review the Claim Summary:
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Identity ConfirmationOn the Transaction Summary (TS) screen, check the customer’s and, if relevant, partner’s identity status. Is the identity status confirmed?
For the customer:
For the partner: If the partner is:
New LIC claims can only be finalised when Identity Confirmation or Alternative Identity is completed in the Identity Confirmation Dashboard. Do not update Proof of Identity (POI) screen. Note: if identity requirements have been met, and the claim presents a POI error, the claim must be regenerated and processed. This is a new claim mapping issue and not related to identity. If the POI error E257CU shows when processing a claim, see details for the error in the Roxy Digital Assistant. | |
Relationship detailsThese details must be reviewed/updated before selecting Process. Relationship details are viewed on the Transaction Summary (TS). The:
Compare relationship details provided in the claim with the details already recorded in the Marital Status (MS) table. Has the customer advised within their claim that they are:
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Separated/single customerIs the customer already current on a payment or benefit?
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Current on payment or benefitIs the customer advising of a change in relationship status within their new claim?
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Partnered customerNote: a Member of a couple (MoC) assessment is not required for a customer and sharer/other person who are claiming or have a current LIC only. Is the customer and/or partner current on a payment or benefit, and the current partner is the same as already recorded?
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Eligibility for LICCheck if the customer has met the basic eligibility for LIC Does the customer qualify for a LIC?
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DocumentsCheck the claim to make sure all required documents have been provided. Have all relevant supporting documents been provided?
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Check for Vulnerable IndicatorA customer identified as vulnerable as part of the LIC claim can submit their claim before completing all required tasks. Does the claim have the keyword 'URGVULN' on the Keyword screen?
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Request more documents or informationIf more details or clarification of the claim or submitted documents are needed to determine the customer's eligibility, make genuine attempts to contact the customer by phone. If the contact was successful and the customer:
If the contact was unsuccessful, or it is not appropriate for the customer to provide the information or evidence verbally:
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Rejecting the claimIs the claim to be rejected?
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Further action requiredAre further actions required?
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ReferralIf more than one referral is required, make sure that all referrals are completed. When a specialist assessment is required:
Complex Assessment Officer (CAO)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. If claim is backdated for any reason, the new LIC start date must be noted in the referral. This ensures CAO’s are applying the correct DOV in their assessment. 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. Compensation Clearance requestSee Coding Compensation and damages (MOD C) to request a clearance for referral instructions. Centrelink International Services Officer (CIS)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. For referral instructions, see Foreign pension coding. Assessment of Care Arrangement referralA completed FA012 form must be lodged as part of a LIC claim, where either of the following is advised:
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. Check if an Assessment of Care Arrangement FA012 form has been returned and referral is required, see Table 2 > Step 1. |
Assessment of Care Arrangements referral
Table 2
Action | |
Check for a completed Assessment of Care ArrangementsGo to Document List (DL). Check the Notes screen to confirm if a care assessment has been completed. One of the below notes may display (this is not an exhaustive list):
Has a care assessment been completed?
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Check for existing referralOn the Notes screen, does a Note with the title 'Care Assessment referral' display with a date after the claim submission?
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Create an Assessment of Care Arrangements referralSelect On the Referral screen:
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. | |
Care assessment finalisedReview the Notes for key information to determine the assessment for child/ren in the LIC claim. This includes child/ren name, date of birth (DOB) and care percentage details. If the assessment outcome is:
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. | |
New child in customer's careIf a new child is in the customer's care:
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Child not in customer's careIf the child is not in the customer's care:
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Processing LIC Claims
Table 3
Action | |
Process the claimBefore selecting Process, make sure all outstanding referrals are completed. If not, place the claim back on Hold for a further 14 days and annotate the Progress of Claim Note. If the relationships details are updated after processing has started, the claim will need to be regenerated by selecting 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:
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:
Use Super Key to go to screens. Key 'Screens' to view a full list. | |
Error MessageThe following system errors display when a LIC NCL is more than 10 months old at date of processing:
Have any of these system error messages presented?
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Assess and code the LIC claimCheck 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 LIC start date defaults to the date of claim lodgement. In some circumstances, based on the information supplied by the customer, Services Officers may need to make a decision on the LIC start date. LIC income LIC entitlement is based on the customer's last 8 weeks 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 and evidence supplied. See Low Income Health Care Card (LIC) income test. Residency 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:
If the POI error E257CU presents when processing a claim, see details for the error in the Roxy Digital Assistant. Do not manually code the Proof of Identity (POI) screen. Has the customer provided all required information?
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Determining a new LIC start date (backdating)To cover medical, pharmaceutical, or other related expenses already incurred, the start date of a LIC may be backdated to a particular date of the customer’s or their dependant’s medical service or treatment. The customer must provide evidence to:
See Determining a backdated LIC start date. The start date field on the LIC Start Date (LSD) screen defaults to the DOR. Has the customer provided evidence and requested the start date to be backdated?
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Referral requiredIf backdating more than 13 weeks from the processing date, a referral will be required. Refer to the Level 2 Policy Help Desk - Concessions. The following information must be included within the referral Enquiry Description:
DOC the customer record to advise a referral has been requested Once response from Level 2 Policy has been provided, go to Table 5 > Step 5. | |
Coding the new LIC claim start dateGo to the LIC Start Date (LSD) screen and select Add. Complete all required fields:
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Dependent children codingDoes the customer have a dependent child/ren in their care?
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Update information on the Child Override/Claim (CHOC) screenThe CHOC screen must be recorded for each child individually, otherwise the child will not be included in the assessment. Go to the CHOC screen:
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Claim outcomeAfter coding the claim:
Is the claim to be rejected?
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Correction of a customer's incorrect LIC Benefit Status line or error 'E082CU - This service reason currently exists for this record' occurs
Table 4
Action | |
Customer unable to claim or renew LIC online because of incorrect Benefit StatusAn issue may occur for some customers claiming LIC or renewal online. This issue occurs if the customers LIC card on the Concession Summary Screen (MCCS) has expired, and the Benefit Status line is incorrectly showing as LIC current. The Benefit status should show as expired/cancelled for those who no longer have a current concession entitlement. Customers who get this error may be unable to start a LIC new claim or renewal online. Service Officers must manually correct the customer's record. When Service Officers attempt to run an Assisted Customer Claim (ACC) the following system error may display, Error 'E082CU - This service reason currently exists for this record' Service Officers must check the following screens in Customer First to make sure the LIC is expired:
Is the LIC cancelled or expired, and incorrectly showing as current on the Benefit Status line?
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Coding the Benefit Action (BA) screenManually cancel the LIC using the BA screen.
Record details in a closed DOC and include the following text:
Advise the customer to submit their claim or renewal for LIC online. If the customer is unable or unsuitable to complete an online claim Service Officers must complete an Assisted Customer Claim (ACC). Procedure ends here |
Index and process a LIC claim in Customer First
Table 5
Action | |
Error messages presenting in Process DirectThe following system errors display in Process Direct when a LIC NCL has not been processed and is more than 10 months in the past:
If the claim is to be assessed/backdated from a date:
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Referral requiredIf backdating more than 13 weeks or claim is more than 52 weeks from the processing date, a referral to the Level 2 Policy Helpdesk – Concessions is required. Update the LIC claim Status to On Hold. The following information must be included within the referral to the helpdesk, Enquiry Description:
Record details in a DOC, including:
Once response from Level 2 Policy has been provided, go to Step 5 | |
Manually index claim in Customer FirstMake sure the System shows as LIC, and:
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Coding the backdated LIC claim start dateThe LIC Start Date screen (LSD) screen must be updated with the correct assessment date. The system will automatically input the Date of Receipt (DOR) used on the IN screen, this needs to be corrected.
Note: Service Officers will need to ensure the claim is actioned the same day it is manually indexed, otherwise the date is no longer applicable. | |
Processing a LIC claimCheck the correct marital status is coded. For example, 'SIN'gle, 'MAR'ried', 'DEFacto', 'WIDowed':
When a customer and their partner have indicated they both wish to claim LIC:
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Residency assessmentThe 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. | |
Low Income Card Task Selection (LITS) screenIf required, update the LITS screen. Select each item for the:
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Coding LIC incomeLIC entitlement is based on the customers last 8 weeks of income from the LIC start date, see Low Income Health Care Card (LIC) income test If relevant, Service Officers must check if income coding has been completed. Employment income
Note: income from previous claims may duplicate and affect the LIC payability. Check before finalising the claim. Lump sum leave payments and redundancy paymentsAre recorded on the Income Maintenance Period (IMP) screen. For coding information, see Low Income Health Care Card (LIC) income test 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. Compensation Lump Sum paymentsAre recorded on the LIC Compensation Lump Sum (LIL) screen This 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. For coding information, see Low Income Health Care Card (LIC) income test | |
Dependent children codingDoes the customer have a dependent child/ren in their care?
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Update information on the Child Override/Claim (CHOC) screenThe CHOC screen must be recorded for each child individually, otherwise the child will not be included in the assessment.
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Finalising the LIC claim activityBefore finalising the claim:
After finalising the claim:
Note: LIC is automatically issued on the card carrier (SS357). No separate grant letter is sent Procedure ends here. |
to view the Claim Summary
> Request documents
> Request documents
> Referral
> Referral.
to complete a SAP refresh
> Regenerate Claim
> Regenerate Claim
> Regenerate claim.