Coding a paper claim for Carer Allowance (CA) where the care receiver is under 16 years 009-03040050

Process the claim on the carer's record.

Has an indexed Social Application (SOA) been created?

• Yes, go to Step 2
• No, create SOA. See Table 1 of Process Direct navigation, common screens and functions

Note: from 1 July 2018, the Contact Claim Details (CCD) screen is read only. See Contact in relation to an intended claim.

• Yes, go to Step 7
• No, go to Step 3

In the CRS screen, key 'Y' in the Add a new Care Receiver or new Link Type? Child field and press [Enter].

• On the Link Person (LP) screen, code the following fields:
• Search Type, key 'CHI'
• Surname of Person, key child's surname
• First Name or Initial, key child's first name or initial
• Gender, key 'M', 'F' or 'X'
• Date of Birth, key child's date of birth
• press [Enter]

If a record for the child:

• exists on the Name List (IL) screen, go to Step 4
• exists and the customer indicates they share care, go to Step 5
• does not exist, go to Step 6

This could mean the child was, and may still be, in the care of another carer. If the CRS screen shows the child as:

• CUR (current) for CA in the Chi Sts field, there may be need to contact the current carer to find out if this a:
• shared care case, which means the Care Details (CDCR) screen of both carers must be updated. Go to Step 5
• change of care case, cancel the CA of the previous carer then go to Step 7
• CAN (cancelled) in the Chi Sts field, the previous carer record requires no action. Go to Step 7

If required, update the details of the new and existing carers on the CDCR screen.

Note: when a declaration of shared care is determined, the percentage of care provided must be coded (before the review period commences) to reflect the person with the greater amount of care is the primary carer.

If this is the first claim to be processed the system will retain the percentage or days in care coded but will default the payment rate of CA to 100%. If both carers claimed on the same date and are eligible from the same date, both can be paid from the same start date providing both claims are processed on the same day.

While shared care provisions do not apply to Carer Payment (CP), the shared care arrangement must be considered when determining eligibility or continuing eligibility for CP. See Assessing Carer Payment (CP) when the care is shared.

Complete the fields:

• Other carer details - In this free text field, key the name of the other carer who would be qualified to receive CA, whether they have claimed CA or not
• If the second carer has not claimed CA, the first carer may receive 100% of the maximum rate of CA until such time as a claim is made by a second qualified carer and a declaration is made under section 981
• If the second carer is receiving CA, also key their CRN and date of birth. If the other carer would not qualify for CA under shared care provisions, no details should be recorded in this field
• See Coding absences for Carer Allowance (CA) where care of the care receiver is shared
• Key the date from which the claim is to be granted in the Effect Date field, or the date the previous carer ceased care, or the date shared care commenced, depending on the details on the claim form and previous/existing carer's record. The date CA is to be shared between 2 carers must not be sooner than 'today's' date (the date of finalising the claim), regardless of the date the claim was made. The only 2 exceptions are:
• If both claims are to be granted on the same date and both qualify from the same date, or
• If the second carer is to be granted as a result of a review of decision within 13 weeks. In these cases the date of effect is the date previously rejected, and the resulting debt shell for the carer who continued to receive 100% CA should be finalised 'No debt'
• Key 1 of the following in the Carer is field:
• 'PAR' - Parent
• 'ORL' - Other Related
• 'URL' - Unrelated (including foster parents)
• 'PTR' - Partner/Spouse
• 'CHD' - Child
• Key the actual number of days the child is in the care of the carer (values are 1 - 14 days) in the Care Days field, or
• Key the actual percentage of care provided to the care receiver (Values are 1 - 100 %) in the Care % field
• When action is finalised, return to the new carer's record, access the CRS screen, and go to Step 7

If a record for the child does not exist, go to the Add Child (ACHI) screen. The following fields will default with information previously keyed:

• Surname
• First Name
• Second Name
• Gender
• Date of Birth
• Proof of Birth
• If proof of birth has been provided, key 'Y'
• If proof of birth has not been provided, key 'N'
• For more information, see Helping customers provide proof of a child's birth
• Add Child 'Y'
• Add another child 'N'

Press [Enter] to view the CRS screen.

• If the link is current for CA, the carer is already receiving CA for this care receiver. Reject the claim for CA. Procedure ends here
• If the CA link is not current: 'S'elect the name and press [Enter]
• The Care Receiver Task Selector (CETS) screen will be displayed. The care receiver information should be in the sub header
• Press [Enter] to accept all the selected screens. See Step 1 in Table 2
• If the link is to Carer Payment:
• 'S'elect the name and key 'Y' in the relevant Add a new care receiver or new link type? field. Press [Enter]
• The Link Confirmation (LC) screen will be displayed, with a Y in the Confirm Selection field. Press [Enter]
• The Care Receiver Task Selector (CETS) screen will be displayed. The care receiver information should be in the sub header

Press [Enter] to accept all the selected screens.

Update the Effect Date field on the Child Medical Details (CDMD) screen.

Change in qualification criteria: If the child becomes qualified due to a change in qualification criteria, the payment cannot be backdated beyond the date the change notification was received

Update Treating Health Professional (THP) details and medical condition(s) on the CDMD screen

Key the following fields:

• The name of the THP who provided the medical assessment in the Name of THP field
• THP's qualification in the Qualifications field
• The Medicare Provider Number in the Provider Number field or 'U' if the THP has not provided this
• A valid value in the Period of Cond field. Note: eligibility for CA child (manual) requires the medical condition to be present for at least 12 months (except where terminal). Processing Service Officers are expected to manually assess this as part of the claim process. An automatic rejection is not generated when a Period of Condition (POC) of less than 12 months (L12) is coded:
• This also applies to claims for Recognised Disabilities and Health Care Card (HCC) only
• If there are inconsistencies with medical information, the Service Officer is expected to query, fully document and update POC as required. For instance, if the THP has indicated a Recognised Disability, which is generally a long term or permanent condition, is likely to last less than 12 months. See Assessing a recognised disability for Carer Allowance (CA) (child)
• THP's contact number in the Contact Number field
• In the Date Signed field, key the date the THP signed the medical assessment, or the date it was received if it was not dated. If it was signed more than 3 months prior to the lodgement of the claim and the Service Office determines it is an accurate reflection of the child's condition, record the date signed by the THP as the date the form was lodged. Make sure this is clearly documented on the customer's record
• Terminal illness Ind field, Number of carers req field, Short Term/Episodic field, End Date field and Extension field will be protected fields unless the claim is for CP (child)

Where the THP selects more than one response in the developmentally linked functional assessment (questions 1 to 8 inclusive) of the medical report, the following applies where:

• the 'age appropriate' response and another response are selected, the specific response (not the age appropriate response) is taken to be the child's best ability, or
• two responses (not including the 'age appropriate' response) are selected the response indicating the best ability is to be taken as the child's best ability. Note: this is different to coding the Care Needs Assessment (CNA)

Update fields relating to the medical condition on the CDMD screen:

• Use field help (?) for coding the Medical Condition field
• Recognised disability is mandatory, used to key a 3 character code for the medical condition of the care receiver. When the updated CDMD screen is re-displayed, the full name of the medical condition is shown. Some types of recognised disabilities are automatically identified by the system. In these cases, the Recognised Disability field is changed to a 'Y' once [Enter] is pressed. A warning is presented, stating the indicator has been changed:
• Other conditions are only recognised disabilities in certain circumstances, so the system does not identify them but displays a warning that the condition may be a recognised disability. This warning must be investigated. If ignored, the system will default N and the full DCLAD process must be performed. See Assessing a recognised disability for Carer Allowance (CA) (child)
• Most recognised disabilities are subject only to a circumstance review. However, a medical review should be scheduled if the diagnosis is likely to change over time. See the Guide to Social Security Guide, 6.2.5.130, CA - Recognised Disability and 16 Years of Age Reviews
• 14 or more hrs extra care weekly? Coding 'Y' or 'N' is mandatory. The carer will be granted HCC only CA if 'Y' is keyed and the carer does not qualify for a fortnightly payment of CA at the end of the grant process:
• If the child has a recognised disability or achieves a qualifying DCLAD 2020, they are considered to automatically meet the conditions of requiring extra care and attention for 14 hours or more per week. It should be noted that POC eligibility requirements still apply to HCC only CA and the Service Officer is expected to manually assess this as part of the claim process
  Note: a claim for CA should not be rejected when the child has a recognised disability or achieves a qualifying DCLAD 2020 score and the THP has indicated N to the question 'Does the child have a disability or medical condition that requires extra care and attention for 14 hours or more per week?' as this question only refers to claims for CA HCC only
• Source and DOR fields will default
• the Action field does not need to be keyed
• press [Enter]

Based on the THP details:

• If the child has a recognised disability and the THP has stated the condition is either permanent or temporary for at least 12 months, see Step 4 in Table 3
• If the child has a recognised disability which is temporary for less than 12 months, go to Step 4
• If the child does not have a recognised disability, go to Step 5

The child's condition is likely to last less than 12 months.

Check the evidence provided, including previous medical reports. Contact the THP to clarify why they consider the condition will be present for less than 12 months.

If confirmed with the THP that the condition is:

• permanent or temporary for at least 12 months, record a DOC with the confirmation information, see Step 4 in Table 3
• less than 12 months, refer the case to the Level 2 Policy Help Desk

If returned from the Level 2 Policy Help Desk and the advice is received that it is:

• Permanent or temporary for at least 12 months, see Step 4 in Table 3
• Less than 12 months, see Step 10 in Table 3 - Child has a recognised disability which is temporary for less than 12 months

Note: the List of Recognised Disabilities (LoRD) contained within the Social Security Guide is broken into 2 categories, Recognised Disabilities and Recognised Medical Conditions.

The Treating Health Professional Assessment (CDTT) screen will display.

Complete all fields, using field help ('?') if necessary, on the CDTT screen with information obtained from part C of the Medical Report - Carer Allowance for a child under 16 years (SA333TDR/SA426)

Press [Enter]. The score will appear on the top right hand side of the screen (under the Birth Date field).

• If the score is less than or equal to 0, manually issue a Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16 years) (SA394) to the carer with a Request for Information (RFI) letter. If the condition is assessed by the THP as less than 12 months, manually issue the SA394 with an RFI letter. The Resources page contains a link to the form
  Note: as an interim measure, Service Officers do not need to request a Care Needs Assessment (SA408/SA394) form from the carer if a THP score of 'zero or less' is achieved and the CA claim can be rejected
• If score is greater than 0, the SA408/SA394 will be automatically issued by the system. Put the new claim activity on hold pending the return of the SA408/SA394 by returning to the AL screen, and coding 'H' in the activity, which will go to the Activity Details (AY) screen. Record the expected date of return of the SA408/SA394 in the Resubmit Date field, and complete the Notes field detailing the reason (return of SA408/SA394)

Has the carer returned the SA408/SA394?

• Yes, see Step 1 in Table 3
• No, reject the claim as failed to reply to correspondence (FRC). Although the PENSA408 letter does not advise of what will happen if the form is not returned by the due date, the claim can still be rejected FRC. Procedure ends here

• Upon return of the completed form, return to the AL screen, and if the new claim activity is still held, key 'U' to return the status to 'STA'
• 'S'elect the CDA/NCL activity, 'S'elect the child care receiver from the CRS screen. Press [Enter] to be navigated to the Customer Details Task (CDTS) screen. [Enter] through the preselected screens, checking details to make sure they are correct
• Go to the Carer Assessment (CDTC) screen. Complete this screen with the information obtained from the SA408/SA394, and using field help (?) for assistance with coding the values:
• press [Enter]
• the CDTC will redisplay with the total score
• press [Enter]

Does the CDAT Validation (CDVL) or Care Load Validation (CLVL) error appear?

• Yes, for claims
• before 1 July 2010 - CDVL screen, go to Step 2
• on or after 1 July 2010 - CLVL screen, go to Step 3
• No, the CDAS screen displays
• CA is payable if the THP score displayed is greater than zero, and details should display on the CJAR screen go to Step 4
• If the THP score is zero or less, CA is not payable. However, the carer will qualify for HCC only CA if the 14 or more hrs extra care weekly? field on the CDMD screen is keyed 'Y' and the THP has stated the condition is either permanent or temporary for at least 12 months, go to Step 4
• If the THP has stated the duration of the condition is less than 12 months, go to Step 9

If the CDVL screen is displayed for claims with a derived date of receipt before 1 July 2010, a process called validation will need to occur.

This means there are possible discrepancies and a validation is required. Fields not requiring validation will be protected. Fields requiring validation will able to be accessed by:

• Keying '?' in the action field beside the validation for help on what to do to validate the assessment. The required action will include contact with the medical assessment provider, and, potentially, a need for a second medical opinion. There may be a need to hold the activity again pending return of information at this point
• Complete the required action on the CDVL screen, using field help '?' to assist with values
• The Child Disability Assessment Tool Summary (CDAS) screen is then displayed
• Press [Enter]
• The Care Receiver Assessment Results (CJAR) screen should then display with assessment result

Validation occurs in certain circumstances which are clearly outlined in the Social Security Guide, 3.6.8.80, CDAT Steps 11-12 - Further Investigation (Validation).

Validation does not occur if the THP score is greater than zero, and the total score is greater than zero.

Go to Step 4

Care Load Validation (CLVL) screen

If the CLVL error SR004 displays on SWE, a process called validation will be required.

Is validation required?

• Yes,
• See Care Load Validation (CLVL) screen
• Go to Step 4
• No, go to Step 4

Complete the fields:

• If the carer indicates they share care and the other carer would appear to qualify for CA, the Other Carer's Details field should be keyed. See Shared care for Carer Allowance (CA)
• Other Carer's Details. In this free text field, key the name of the other carer who would be qualified to receive CA, whether they have claimed CA or not:
• If the second carer has not claimed CA, the first carer may receive 100% of the maximum rate of CA until such time as a claim is made by a second qualified carer and a declaration is made under section 981
• If the second carer is receiving CA, also enter their CRN and date of birth. If the other carer would not qualify for CA under shared care provisions, no details should be recorded in this field
• Date from which the claim is to be granted in the Effect Date field
• Key 1 of the following in the Relationship to Care Rcvr field:
• 'PAR' - Parent
• 'ORL' - Other Related
• 'URL' - Unrelated (including foster parents)
• 'PTR' - Partner/Spouse
• 'CHD' - Child
• Key the number of days the child is in the care of the care receiver (Values are 1 - 14 days) in the Care Days/Fortnight field, or
• Key the percentage of care provided to the care receiver (Values are 1 - 100%) in the Care % field
• The Carer field will default after pressing [Enter] once
• Press [Enter] again

Repeat the process for every care receiver whose disabilities are included in the combined qualification.

When the process has been completed for all care receivers, go to Step 6.

• Yes, in a separate activity, cancel the CA (child) payment on the Care Receiver Benefit Action (CJBA) screen for the member of the couple receiving payment. Note: this cannot be done in the same activity as the new claim. The new claim does not need to be cancelled to cancel the existing payment to the other member of a couple. 'S'elect the new claim activity, go to Step 7
• No, go to Step 7

If the care receiver is in hospital, record the details on the Absence Details (ABSN) screen.

Set up a review for 6 months (or until the care receiver is no longer expected to be dependent on the external assistance apparatus) if the care receiver has either:

• a chronic respiratory disease requiring home oxygen, or
• a condition where they are dependent for their health on an external apparatus/machine called a ventilator to assist with breathing (either on a continuous or intermittent basis), or
• a gastroenterological condition or other medical condition requiring total parenteral nutrition for an extended period, with medical treatment and medical supervision required for at least 12 months

Income coding and verification requirements for CA new claims differs according to:

• whether the carer is single or partnered
• whether or not the carer or their partner receives a qualifying payment or card that allows an exemption from providing their income details

Is the carer or their partner receiving:

• Centrelink income support payment
• Department of Veterans' Affairs (DVA) Income Support Payment
• Family Tax Benefit (FTB), or
• Commonwealth Seniors Health Card

Go to Step 10.

If the carer is not exempt from providing their income details for the CA income test:

• Key the Adjusted Taxable Income (ATI) details, to do this go to the Carer Allowance Adjusted Taxable Income (CAATI) screen using Process Direct. See the Coding CA Adjusted Taxable Income (ATI) details - paper claim table in Coding a paper claim for Carer Allowance (CA) where the care receiver is 16 years or over
• If the claim start date is prior to 20 September 2018 but processed after this date, a CA income test review will be automatically generated after the grant not requiring the CA income test details at time of grant
• If the income is too high, CA will reject - CA adjusted taxable income in excess of threshold
• If the reason for a current year estimate is not accepted, CA will reject - estimate not acceptable

Although the child has a recognised disability, to qualify for CA the condition must be expected to be present for at least 12 months.

Check all medical evidence on record including previous medical reports.

Contact the THP to clarify why they consider the condition will be present for less than 12 months.

• If confirmed with the THP that the condition is:
• permanent or temporary for at least 12 months, record a DOC with the confirmation information, go to Step 10
• less than 12 months, refer the case to the Level 2 Policy Help Desk for advice
• If returned from the Level 2 Policy Help Desk and the advice received is the condition is:
• permanent or temporary for at least 12 months, record a DOC with confirmation information
• less than 12 months, record a DOC with the information, go to Step 11

Note: the List of Recognised Disabilities contained within the Social Security Guide is broken into 2 categories - Recognised Disabilities and Recognised Medical Conditions.

If all other coding completed, finalise the claim.

Record the details on a DOC in the carer's record.

Tell the carer of the outcome.

As the system will incorrectly grant CA, reject the claim manually and send a manual advice.

To reject the claim:

• Code a manual rejection reason of 'NDP'
• Inhibit the advice
• Send a manual advice

See Rejecting a Carer Allowance (CA) claim