Processing claims for Carer Payment (CP) and/or Carer Allowance (CA) 009-04040000

Locate the work item in Process Direct. See Process Direct navigation, common screens and functions to launch the tool and access work items.

Select the work item to view Customer and Activity Information.

CP and/or CA submitted online claim/ via ACC

A Social Online Application (SOA) new claim work item is generated on the carer's record. This contains all the claim details given by the carer online or entered into ACC.

CP and/or CA paper claim is scanned to the carer's record

• A SOA shell work item is generated on the carer's record
• Claim details, including the benefit type will need to be manually updated into the work item using details from the scanned claim form and any supporting documentation
• If no SOA shell exists, create a SOA shell from the Process Direct landing page

One payment claimed

Under 'Instructions for the customer (carer)'on the Medical Report, the carer must select whether they are claiming for CP and CA, or for CA only.

For example, on the Medical Report:

• the carer selects CA only
• the Treating Health Professional (THP) marks the claim is for CP and CA, or does not answer

In this case, the claim is assessed for the payment the carer has selected on the initial claim.

• Assess the claim for the payment the carer has selected on the initial claim, not both payments, even if the THP has selected both payments on the Medical Report
• The carer must also be given the opportunity to lodge a claim for either CP or CA (depending on the claim lodged)
• When the claim for the other payment has been received, consider if special circumstances apply to the start date

For what to check upon lodgement, see Claiming CP and/or CA.

Note: if a SOA was incorrectly created and no paper claim has been lodged, do not reject the claim. Set the SOA to 'not required'.

Review information to:

• find out if more action is required
• compare information during assessment of the claim, or
• place the claim on hold

If the carer or care receiver is absent from the care situation or the care receiver has died, vulnerable circumstances may be affecting the carer’s ability to submit a claim. See Complications to grants of Carer Payment and/or Carer Allowance.

The Customer and Claim Activity table displays key information, including the:

• claim status
• date the claim was submitted by the carer (WEB Channel), via ACC or created as a SOA shell (internal)

Link Summary (LS) or Marital Status (MS) tables may contain provisional or confirmed data relating to the carer's relationship status and linked records. For example, partner and care receiver records.

Select at top left to view/access linked record details.

Claim Overview

Select at top left to view a claim summary of information provided by the carer, including documents provided by the customer (uploaded online).

Claims created as a SOA shell will not contain claim information or uploaded data. Information needs to be manually updated from the original claim (for example, paper claim).

If only part of the paper claim has been lodged (for example, SA404 without a SA406 or SA407), and a Q999:

• has been previously issued to request all forms, go to Step 7
• has not been previously issued, see Claiming Carer Payment (CP) and/or Carer Allowance (CA)

DOCs/ Tasks/ uploaded documents

Select:

• at the top right to display icons
• Tasks to view documents requested online or via ACC or documents provided and their status, for example, accepted
• Notes to view claim progress notes and details of any changes since the claim was submitted. Action these changes when processing the claim

Use the Super Key field to go to screens. This will display the relevant table/s.

Key DL in the Super Key field to view DOCs on the Document List (DL) screen.

See Process Direct navigation, common screens and functions.

Documents lodged

If documents have been provided separately, for example, after the claim was submitted, select Tasks, and update the task status to 'Accepted'.

Contact details updated online

If a carer has updated their contact details online after submitting their claim, complete the started CDC activity on the Activity List (AL) screen in Customer First.

Inter-environment transfer

Process Direct will warn of environment transfers of a partner, child, or care receiver if they are not in the same environment as the carer.

Note: only records linked to the carer can be transferred to a different environment using Process Direct, and only into the same environment as the carer's record. The carer's own record cannot be transferred.

To initiate an inter-environment transfer of records, see Inter-environment change of address (ICoA) transfer of a customer record.

Rent Deduction Scheme (RDS)

Before actioning any inter-environment transfers for either the carer or care receiver records, processing staff should check the Payment Instruction Summary (PINS) screen to see if these customers are having government housing payments deducted from their payment as part of the Rent Deduction Scheme (RDS).

Actioning an inter-environment transfer for a customer that is participating in the RDS, will see their deductions automatically cancel. Processing staff should check for this before taking action on the record. For more details, see Rent Deduction Scheme (RDS) deductions.

If there is no way to avoid a cancellation of RDS deductions, staff should advise the customer that their deductions will cancel and they need to contact their housing authority to have the deductions re-instated.

Compensation details

If the carer has provided new compensation details, complete a compensation referral and place the work item on hold.

Contact the carer to confirm details in the following situations.

Care receiver getting CA for another adult care receiver

The care receiver cannot qualify for CA for another disabled adult.

Before granting, rejecting, or cancelling any CA payments:

• more details are needed from the carer and the care receiver to clarify the circumstances, and
• confirm if the care receiver has ceased providing care

Where another person is already/still providing care for the care receiver, see Change of Care for Carer Payment (CP) and Carer Allowance (CA) customers.

When determining the start date for CA, the decision is independent of:

• whether the care receiver has been paid CA
• the date CA was cancelled or
• whether the care receiver is entitled to CA

The start date determination should follow the normal start date procedures that apply for new claims.

Care receiver getting CP for another care receiver

There is no legislative restriction on a carer receiving CP for a care receiver who in turn receives CP for caring for another care receiver. However, in this situation, a social worker can help decide whether both carers are personally providing constant care and therefore qualify for CP. See Eligibility for Carer Payment (CP) when a care receiver is aged 16 years or over for more details when the care receiver is a carer.

See the Resources page for details on when a care receiver receives either CP or CA.

Multiple CP claims/care receivers

If a carer lodges multiple claims for CP for 2 or more carer receivers:

• it is deemed that the customer has lodged a claim for each care receiver
• each claim must be assessed
• if the carer is eligible for more than one care receiver, a determination of who the carer is claiming for must be made

If a carer is already in receipt of CP for one care receiver and lodges a secondary CP claim, it must be determined if this is a change in care receiver.

See Table 2.

All processing staff are to stream claims before making a referral or placing the claim on hold.

Streaming is the practice of coding of all information that has been provided or is available when the claim is first allocated. This includes:

• identity for carer and care receiver
• medical Information
• income and Asset details
• care receiver information
• other details that need coding, provided with the claim
• check notes on the record (e.g. has there been an earlier claim? Is a reassessment required?)

This makes sure claims are not being placed on hold unnecessarily, where a decision could be made about the claim.

Example: where a claim needs a referral to an external assessment such as a Complex Assessment Officer, but the medical report given indicates that the customer does not meet medical qualification for the respective payment.

There is enough information to make a decision about this claim without proceeding with a referral.

Note:

• if the carer has lodged a claim for CA (child) within 28 days of receiving a notification for CP (child), the date of claim for a CA (child) may be able to be backdated. See, Eligibility for Carer Allowance (CA) (auto) when a carer is also receiving Carer Payment (CP) (child)
• for claims that have been streamed, see Hold to user new claim criteria to determine if claim can be held to user

Check claim requirements met:

• identity confirmation for the carer is needed for CP and/or CA. Original documents must be sighted, recorded and returned. For requirements, see Coding identity documents
• identity confirmation for care receivers, see Identity confirmation
• for claims submitted via ACC:
• confirm a verbal signature declaration has been made
• check the Notes or the Customer Claim Summary sections of Process Direct to see confirmation DOC of verbal declaration acceptance
• accepted verbal declarations should be recorded in an automatic DOC or the claim summary displays as 'staff assisted verbal declaration accepted - Yes' or 'online customer declaration accepted - Yes'
• Australian residence
• Tax File Number (TFN)
• Bank account details for direct credit, or payment nominee details for paper claims
• check Medical Reports have been lodged
• any other details and documentation required to assess the claim

Have all of the relevant details been provided?

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

Processing staff are not required to re-request information/documents listed as requested in Tasks.

Note: consider the carers circumstances and vulnerabilities before determining not to re-request.

If more information or documentation is required, processing staff can accept and use verbal details from the customer where claims received are incomplete or incorrect.

This may include, but is not limited to:

• missing, incomplete or hard-to-read responses on a form
• conflicting information in a claim for example, carer advises they:
• live with the care receiver, but the addresses differ
• have 100% care of the child and the SCA screen on the child’s record (in PD) shows different information
• additional earnings information that covers the date the customer is claiming from (extra to payslips requested with the claim)

Service Officers must not place customers on reporting to grant a claim, in lieu of requesting the necessary earnings information.

If a customer’s or partner’s earnings are variable and they cannot provide accurate details over the phone:

• verbally request payslips for the relevant period
• update the progress of claim doc with the request
• place claim on hold

Service Officers must not verbally obtain entire forms the carer would otherwise need to complete for their claim. For example, if the carer and care receiver are not co-residents, the details of an SA381 cannot be taken verbally. The carer would need to provide the completed SA381.

Make genuine attempts to contact the carer by phone to get or clarify missing information claim details. Record this information in the claim Progress Note and/or DOC.

If verbal information is not possible or practical to get send a written request.

The History Summary (HS) screen shows information/documents requested. If more information is needed to support the carer's claim, the:

• request needs to detail the information originally requested, and
• extra information

If requested documents have not been provided within the relevant timeframe from the date of the original notice, the claim can be rejected FRC.

Circumstance Change Monitor (CCM) rules allow a claim to be submitted without the carer providing all the documents necessary for their claim to be assessed. Do not reject these claims until the carer has been given an opportunity to lodge the outstanding documents.

See Table 8 in Circumstance Change Monitor (CCM).

Place the claim on hold until the date the documents are due to be returned.

If it is clear the claim will be rejected:

• record the information already provided with the claim including care needs/THP
• it is not necessary to request more details before the claim can be rejected

Relationships must be reviewed/updated before starting to process a claim. These include partner, child, and care receiver relationships.

Action required depends on:

• the carer's circumstances
• what they have advised on their claim and
• what is already recorded on their record (confirmed data)

If the customer's partner used the Temporary Access Code (TAC) given at the end of the claim and confirmed the relationship using the 'Partner Confirmation Logon' service on the Services Australia website, it displays as a DMOPD tile. It will be available to view in scanned documents.

See:

• Documents required for Centrelink new claims
• Confirming a partnered relationship

In some cases, the claim may need regenerating to allow changes to relationships.

View/update details via the Transaction Summary (TS) screen in the Link Summary (LS) and Marital Status (MS) tables.

Relationship details may only need updating if the tables contain different details to the details provided in the claim.

Note: only delete/edit relationship data if recorded in error. If the relationship data is no longer applicable, for example, the carer has married, add a new line.

To correct a relationship (for example, the relationship is displaying as NRE - Not Required), select:

• Edit to update the status
• Save

To end or add a new relationship:

• select Add above the relevant table
• on the Create Relationship / Martial Status screen, key the event date and the relationship status
• if becoming partnered:
• select Search Criteria
• key mandatory details of Last Name and Date of Birth, or enter the partner's Customer Reference Number (CRN) in the External Type/No field
• select Go to search for the partner's record
• from the search results, select option to select the CRN
• update the Partner Permitted to Enquire field
• Save

If the function to update details in these tables is not available, select > Regenerate claim and then return to update details.

The customer's Australian residence qualification will be auto-assessed based on the residence information recorded. See Residence assessment for customers claiming Carer Payment.

Residence information must still be recorded if the claim is to be rejected for a reason other than residence. If residence details are not recorded, the:

• system overrides any other rejection reason, and
• claim rejects for a residence related reason

If residence requirements are not met but the customer has lived in an Agreement country, they may be qualified for Carer Payment under an Agreement.

Does the customer qualify under an International Agreement or is the customer claiming as a non-protected Special Category Visa holder?

• Yes:
• code all residence screens
• confirm the customer's identity
• leave required work items open
• take the claim off hold and categorise in Work Optimiser to a CIS new claim work item
  Note: no separate referral needed. Procedure ends here
• No, go to Step 10

Select > Referral.

Select the referral type:

• Compensation Clearance request:
• If the carer has provided new compensation details, complete a compensation referral
• Complex Assessment Officer (CAO):
• Refer to CAO when the customer has complex financial circumstances, such as trusts and companies
• In the Referral Details section, select the referral reason/s. See Identifying and making suitable referrals to the Complex Assessment Officer (CAO)
• International Services (CIS):
• Refer to CIS when the immigration data transfer from the Department of Home Affairs is not successful, or for foreign pension coding assistance
• In the Referral Details section, if needed, select the country. Key any additional information to help CIS staff as per the Operational Blueprint process

Select Finish to complete the referral. This will update the claim status to On Hold.

Note: for streamed claims, see Hold to user new claim criteria to determine if claim can be held to user.

Social Worker Referrals:

Claims from carers must be referred to a social worker when the carer is:

• under 18 years of age, (before processing the claim)
• over 80 years of age

Before making a Social Worker referral

Service Officers must:

• assess the claim to determine basic eligibility, and
• not finalise the claim

To complete a referral to a Social Worker, see Social worker assessment of care situations for CP and CA claims.

Social Worker is not able to complete assessment

• If the Social Worker is unable to speak to the carer within 21 days and the customer is under 18, the social worker runs the CSAT Young Carer Assessment unsuccessful Fast Note. This tells the Service Officer attempts to contact have been unsuccessful
• On receipt of the unsuccessful Fast Note, Carer Processing Service Officers must reject the claim FRC

Check the PRECLM screen in Process Direct to review whether intention to claim provisions may apply.

Some vulnerable circumstance reasons must be recorded manually. Review the customer's circumstances and decide if a circumstance needs to be recorded manually.

Process Direct automatically adjusts the start date if:

• there was a contact within 14 days of the claim submission date
• an automatic or manual circumstance has been recorded, and
• the vulnerable circumstance date was within 8 weeks of the contact date

However, when adjusting the start date Process Direct does not consider:

• if the customer was qualified on that date (required to fully meet intention to claim provisions)
• contact date for intent to claim is more than 14 days before claim lodgement
• backdating provisions apply (in addition to intent to claim provisions)
• other deemed claim provisions, such as inappropriate claims or incorrect claims

When processing the claim, the start date may need to be adjusted manually if:

• the start date returned from ISIS is different to what Process Direct displayed on the PNA or CJBA screen and the customer was qualified on a subsequent contact date before the claim was submitted
• intention to claim provisions apply and the customer is eligible for an extension to lodge up to 13 weeks after the contact date
• other backdating provisions apply
• inappropriate or incorrect claim provisions apply

If processing an Assisted Customer Claim, before updating the receipt date, see Table 2, Step 11 in Viewing and processing online and Assisted Customer Claim (ACC).

Has the date submitted defaulted to the date of receipt (DOR) entered?

• Yes, follow the workaround in Table 2, Step 11 Viewing and processing online and Assisted Customer Claim (ACC)
• Once the workaround has been completed return to this procedure, go to Step 13
• No:
• Select > Update DOR
• Record new receipt date details
• Select OK to change the receipt date
• Updating the Date of Receipt will auto-regenerate the claim and remove any coding completed. Only update receipt dates in line with business processes
• Note: selecting Update Date of Receipt will bypass the Process Direct function of automatically adjusting the start date under intention to claim provisions. If this is done, see Intent to claim and vulnerable customers to determine if intent to claim provisions apply and adjust the start date manually
• go to Step 13

Processing staff are required to update the Progress of claim DOC with all information relevant to the claim.

Note: update the Progress of Claim DOC within the sub-heading 'Document list / notes' under the Notes tab of Process Direct. This will make sure any annotations made will also present on the DL screen in Customer First.

Updates to this DOC should include, but is not limited to:

• referrals made from streaming the claim
• information requested/outstanding from the customer
• any findings from coding information already provided. For example, DCLAD or ADAT result

If there is no existing DOC on the record for this claim, create a new one.

Is the claim ready to process or is carer receiving JobSeeker Payment?

• Yes, see Table 5
• No, select for relevant option to place the claim (work item) on hold.
  Note: if claim is being held to user, see Table 5 in Work Optimiser for Staff

Multiple claims occur when a carer:

• has submitted a claim for CP for 2 or more care receivers, or
• is already current on CP and has submitted a CP claim for CP for a new care receiver

Note: system limitations allow only one claim finalisation letter to be generated each day.

If a customer has multiple claims for CP to be assessed, Service Officers must:

• only finalise one claim per day, to ensure the carer receives all outcome letters
• finalise rejected claims first, and
• finalise granted claims last

Has the carer lodged multiple claims for CP or are they already getting CP and have submitted a claim for CP for a new care receiver?

• Yes, go to Step 2
• No:
• if the carer has submitted a CP and/or CA claim as a request for a review of a decision, after the rejection of a previous claim for CP and/or CA, go to Step 7
• otherwise, see Table 3

Decide if the carer will qualify for CP for the care receivers by checking the:

• carer provides constant care on a daily basis, and
• THP and ADAT scores for the care receivers being claimed for

Provisionally code the care receiver’s medical and care details, within the new claim/SOA if possible.

Where the carer is already CP current, the provisional medical and care details coding needs to be completed in an activity outside of the claim (in Customer First or Customer Record).

Does more than one of the care receivers qualify the carer for CP?

• Yes, go to Step 3
• No, go to Step 6

If 2 or more qualifying care receivers qualify the carer for CP, the carer must be the person who decides which care receiver they want to claim for.

Make genuine attempts to contact the carer by phone to discuss:

• the circumstances of the qualifying care receivers
• that CP can be paid for only one care receiver
• if a change in care receiver, multiple care, or combined care applies
• bereavement provisions (if applicable)
• who the carer wishes to continue a claim for CP for

Was phone contact successful?

• Yes, go to Step 5
• No, go to Step 4

Send a QSS32 letter to the carer to request contact.

Record details in the claim progress Note or DOC on the carer’s record:

• the names of the care receivers the carer is claiming for
• the date and time of contact attempts made
• details of the QSS32 issued and questions asked
• details to be discussed with the carer if they contact

Hold the claim for the required response time (until day 22 unless other wait time provisions apply).

Once the claim has come off hold, has the carer now identified the care receiver they want to claim CP for?

• Yes, go to Step 5
• No, go to Step 6

All claims received by Services Australia must be:

• assessed
• coded, and
• processed

Do not offer to withdraw the customer's claim. Withdrawal of a claim is taken to have not been made, meaning all information (including medical) within the claim cannot be used.

Record details of the discussion with the customer on a DOC.

Did the carer request to withdraw any or all of their claims?

• Yes:
• see Withdrawal of claims, and
• process any remaining claims (if needed)
• No, all claims need to be processed, go to Step 6

If the carer will not qualify for any of the care receivers, before rejecting the claims, check if any of the following apply:

• Carer Payment (CP) (child) when caring for 2 to 4 children each with a disability or medical condition (combined care)
• Eligibility for Carer Payment (CP) under the Lower Adult Disability Assessment (ADAT) Tool
• Carer Payment (CP) (child) when caring for a disabled adult and 1 or 2 children with a disability or medical condition (multiple care)

Follow this step to:

• reject claims for non-qualifying care receivers, and
• grant a claim for one qualifying care receiver, where applicable, or
• reject claims 'failed to reply to correspondence (FRC)', when contact attempts are unsuccessful

CP claims for multiple care receivers cannot be assessed in one claim, however all claims must be finalised. If claims have been made for more than one care receiver, the rejection/s must be finalised before a grant. Only one claim can be finalised each day.

To finalise all claims and check outcome letters are issued for each claim, the following steps must be taken.

If rejecting any of the claims, see Rejecting a Carer Payment claim or Rejecting a Carer Allowance claim.

One or more claims to be rejected, one claim to be granted:

• Set the original claim to 'Not required'
• Create a SOA for the claim that is to be rejected first
• Code all claim details
• Finalise rejection of the first claim using the non-qualifying reason or FRC if applicable
• Place the other claim/s on hold. Note: this may be for several days if the customer has lodged more than 2 claims
• Staff should add the customer’s CRN to their Actor Relationship Manager (ARM). See Work Optimiser for staff
• The rejection letter for this claim will generate and be automatically issued to the customer
• Repeat this process for any additional claims to be rejected
• Contact the customer as per normal SOI requirements. Tell the customer of all the claim outcomes as well as their obligations and appeal rights
• Once all rejected claims have been finalised, return to the claim that is to be granted (if applicable)
• Re-check the original coding and make sure the claim outcome has not changed at the Entitlement (ELD) screen
• If granting the last claim, create and process a final SOA to grant CP for the qualifying care receiver
• The grant letter for this claim will generate and be automatically issued to the customer

All claims to be rejected:

• Select one of the customer’s claims and reject it
• Place the remaining claims on hold. This may be for several days if the customer has lodged more than 2 claims
• Staff must add the customer’s CRN to their ARM. See Work Optimiser for staff
• The rejection letter for the claim will generate and be automatically issued to the customer
• Repeat this process with all of the remaining claims

Once all the claims have been finalised, staff must remove the customer’s CRN form their ARM.

If the granted claim was processed first, or Carer Payment is current:

• A new CP claim cannot be indexed/ finalised
• The outcome is considered as 'Rejected'
• Record details of the claim and non-qualifying care receiver/s or FRC rejection in a Note or DOC on the record. Record as much information as possible
• Contact the customer as per normal SOI attempts when rejecting a CP claim
• Send a Q134 manual letter to the carer advising them of rejection (include all care receivers in the letter)
• Set the claim to 'Not Required'

If a carer is already in receipt of CP for one care receiver and lodges a secondary CP claim, and it is determined this is a change in care receiver:

• cancel the CP from Date Paid To (DPT) -1 using cancellation code OTH - Other:
• Before finalising the cancellation activity, create a manual Q134 letter to advise of the cancellation. See Creating a Q134 letter
• manually adjust the resultant debt:
• debts of less than $50 automatically waive, these debts require no action
• for debts of $50 or more, see Manual Adjustments
• grant CP from DPT+1 for the new care receiver
• Record details of the discussion about changing CP carer receiver on a DOC on the carer's record and add the approved text:
• Due to a system limitation, CP for previous care receiver has been cancelled from Date Paid to - 1, and CP for new care receiver has been granted Date Paid to +1. Carer has had continuous, ongoing entitlement to CP and has not had a break in payment

Note: cancelling CP (child) will also auto-cancel CA (auto).

To ensure the carer is advised of the correct cancellation date, a manual cancellation letter Q134 is also required. For more details, see Creating a Q134 letter. This ensures the correct date of grant appears on the carer's Pensioner Concession Card (PCC) and the grant letter.

Is CP already current and has the carer failed to reply to correspondence regarding a claim for another care receiver?

• Yes, start a review on the carer’s record to confirm they are still providing care to the initial care receiver. Follow Reviews of Carer Payment (CP) and/or Carer Allowance (CA). If there is no response to the review, see Cancellation and suspension of Carer Payment and/or Carer Allowance
• No, procedure ends here

Has the carer submitted a new claim within 13 weeks of the previous claim being rejected?

• Yes, go to Step 8
• No, see Table 3 to process the second claim by itself

Will the claim be granted?

• Yes:
• Update the DOR of the new claim activity to the date of the original claim lodgement and grant CP and/or CA based on the original claim
• Contact the customer and tell them their claim has been granted, from the original claim date and they will receive a grant letter
• Annotate grant DOC on the carer's record to indicate a Secretary initiated review of decision (Section 126 SSA 1999) was undertaken based on the information within the second claim, lodged within 13 weeks of the previous rejection
• No, see Table 3 to process the second claim and reject CP and/or CA

Does a provisional Care Receiver link present as part of the claim?

• Yes:
• the link is 'Unconfirmed' see Table 4
• otherwise, see Table 5
• No, go to Step 2

Where a care receiver link cannot be established on the Link Summary (LS) screen Service Officers must:

Undertake all normal checks on the record (DOR, claim status) to make sure record accuracy.

Note: for CP/CA child claims, where the customer has also lodged a claim for FTB for the child care receiver, staff do not need to hold CP/CA claims waiting for the FTB claim to be finalised. Customers do not need to be either FTB current or have claimed FTB to claim CP/CA for a child.

For assistance in linking a child record, see Linking a child to a customer's record.

Select and to expand the claim review panel to view scanned documents.

On the review summary, check scanned documents for the following documents:

• SA404, SA406, SA341, SA407
• Legacy Carer Payment and/or Carer Allowance claim forms, for example SA336, SA337, SA410, SA411 or SA409
• Assessment for Carer Payment under an international Social Security agreement form (AUS156)

Open the relevant scan and check it is complete and signed by the customer.

The claim form will have details of the care receiver recorded. Check their full name, DOB and CRN has been included. The form may indicate if the customer is claiming Carer Payment as well as Carer Allowance.

Note: some forms do not ask for the care receiver’s CRN, it may be on the SA332(a) medical report. If not located on a form, further investigation to identify the care receiver may be needed.

Go to the TS screen, scroll down to the link summary, and select Add to add a new link. This will open 'Create Link Summary'. Complete the following fields:

• Link Type: CAR
• From SVC Reason: CAR or CDA
• To: CRP or CRA or CRC
• Start Date: receipt date of claim/date of effect for claim
  Move the start date to the earliest Entitlement Period Start Date the customer is payable from it:
• the income is too high for CP to be payable
• the customer will become payable within 13 weeks of the date they lodged the claim
• Select Destination CRN field
• Update Search and Select CRN with care receiver's full name and date of birth

Note: where the care receiver’s CRN has been provided, enter this into the free-text field to the right of 'External Type/No' and select 'Go'. Repeat this process for each link type needed.

Select the appropriate record. Create Link Summary will populate the care receiver's CRN in the Destination CRN, select Save.

If the Service Officer cannot locate the care receiver or is unsure of the search results, request more information to identify the care receiver.

The TS screen will display the Care Receiver link in the Link Summary (LS) with a record status code of 'Provisional'.

See Table 5 to continue with processing.

Service Officers must check existing and previous links on the carer's record.

Are there any more details about the care receiver located on the carer's record?

• Yes, go to Step 3
• No, go to Step 2

Locate the Care Receiver details under the 'Care Receiver Profile' section of the carer's claim review panel.

Has the carer provided enough details to identity the care receiver on the system (for example, full name, date of birth)?

• Yes, go to Step 4
• No, go to Step 3

Select and to expand the claim review panel to review scanned documents.

Has the carer provided identity documents and/or a medical report for the care receiver?

• Yes, go to Step 4
• No, request required details

Go to the TS screen, scroll down to the link summary, select Edit of the unconfirmed link.

Go to the Care Receiver Summary (CRS) screen, select Edit of the unconfirmed link:

• update the 'Change Care Receiver Link'
• update 'Search and Select CRN' with the care receiver's details. If the care receiver cannot be located or unsure of the search results request more information to identify the care receiver
• if correct care receiver details are located, the 'Create Link Summary' will populate the care receiver's CRN in the 'Destination CRN', select Save

Note: where the CRN has been provided, key this into the free-text field to the right of 'External Type/No' and select 'Go'. Repeat this process for each link type required.

The TS screen displays the Care Receiver link in the Link Summary (LS) with a record status code of 'Provisional'.

See Table 5 to continue with claim processing.

Complete pre-claim processing checks such as record correctness, claim correctness, and care receiver links.

Select Process to start the claim.

Note: Carer Processing staff must select Process to start processing the claim before going to any other screens. Failure to follow this sequence results in information coded by staff not being read correctly by the system and results in incorrect outcomes.

Resolving incorrect outcomes

Errors occur when staff do not follow the correct processing sequence. If Carer Processing staff have issues with incorrect outcomes (for example, claims rejecting when they should be granting), use Roxy to raise an incident to resolve the issue before claim processing can occur. Once issue is resolved, continue processing the claim.

After selecting Process, the Errors (SWE) screen displays.

Message Log

This section displays any errors with existing coding. These must be fixed before the claim can be assessed.

Task Selector/s

Consider these list common screens as part of the claim. Task Selectors that contain mandatory screens are pre-selected.

Note: Task Selectors may not list all screens on which information may be coded during the claim. Other screens may need to be checked to compare historical information on the record with information provided within the claim:

• a flag displays against listed screens that contain provisional data uploaded from the online claim, ACC or added by a previous staff member. These may not need to be accessed to process the claim
• select screens to be checked/updated. There is an option to select all screens
• select Next to proceed through selected screens

Screens can also be accessed directly via the Super Key. For example, key 'CRS' to view the Care Receiver Summary (CRS) screen.

For paper claims, manually code details from the paper claim form.

Linked records

If data needs to be updated on a partner, care receiver or child record select and select the correct record. Return to the customer’s record the same way to continue processing the claim.

Start date

• The claim start date is calculated by the system. It can be changed manually if needed
• The system start date is used throughout the claim as the first date of event for most updates, including where the system indicates an adjusted start date under intention to claim provisions
• If the start date is manually changed to an earlier date, the date of event of provisional coding will also need to be updated
• If the claim is submitted on the day the care receiver passed away, and the carer:
• has contacted before the date of death and is experiencing vulnerability, the start date is the earlier date
• has not contacted before the date of death, the carer is entitled to CP and CA from the date the claim was submitted. The system will not allow the claim to be granted from the date the care receiver passed away. The start date should be amended to the previous day

Where the employment income coded for the initial entitlement period(s) is too high to grant CP from the start date, or the carer was working more than 25 hours per week, but the customer will become payable within 13 weeks of the date they lodged the claim, move the start date for CP on the PNA screen to the earliest Entitlement Period Start Date (EPSD) that the customer is payable from. This will prevent the claim from rejecting due to high income.

Move the start date to the next Entitlement Period Start Date:

• if the income coded for the first entitlement period is too high to grant from claim date, but
• the customer will become payable within 13 weeks of the date they lodged the claim

This will prevent the claim from rejecting due to high income.

See Process Direct navigation, common screens and functions.

Update details via the Customer Data Task Selector (CDTS).

The available tasks for selection to check/update include:

• Customer Personal Details (CPD)
• Office Code (OC)
• Other Contact Details (OCD)
• Address Details (AD)
• Accommodation (ACS)
• Email Address (EMA)
• Telephone Details (TDS)
• Payment Destination Details (PAS)
• Proof of Identity Details (POI)
• Tax File Number (TFN)
• Nominee Link Summary (NOLS)

Update details via the Residency Task Selector (RETS).

The available tasks for selection to check/update include:

• Legal Residence Details (RSLEG)
• Country of Residency (CRES)
• Immigration Enquiry (RSIMME)
• Immigration Movements (RSIM)
• Customer Advised Travel (RSCD)
• Additional Residency Details (ARD)

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

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

The new claim process will attempt a datalink with the Department of Home Affairs. If successful, the datalink will auto-record a carer's visa and movement information from 1 September 1994 and grants of Australian citizenship where available.

To record residence details, see Residence and Portability screens.

Select View/Access linked records and select the care receiver.

If the care receiver is an Adult, check/update Customer Details tasks:

• go to the Customer Detail Task Selector (CDTS) screen
• check/update any of the preselected (flagged) tasks, select both 'POI' and 'OC' plus any other tasks needed

Note: if a care receiver's POI has been uploaded by the carer, this can display on the carer receiver's record instead of the carers. Check the carer receiver's record before rejecting the claim.

Identity status

When coding care receiver POI, there is no requirement to include the service reason.

If the care receiver:

• meets the POI requirements for this claim, code YES in the Process Direct POI screen
• does not meet the POI requirements for this claim, code NO in the Process Direct POI screen

Go to the Care Receiver Tasks Selector (CETS) screen. The mandatory tasks will be preselected and provisional data from the online claim or ACC will display a flag.

The following tasks can be selected to check/update:

• Disability Assessment Tool (ADAT)
• Child Disability Assessment Tool (CDAT)
• Care Load Summary (CLS)
• Care Details (CDCR)
• Accommodation (ACS)
• Care and Institution Details (CRCI)
• Care Receiver Income and Assets (CRIA)
• Care Load Validation (CLVL)
• Absence Enquiry (ABSN)
• Exchanged Care (CECS)
• Carers CSAT Referrals (CLCRF)
• Residency Details, see the Residence requirements for care receiver table

Select Next to move to next selected screen in screen flow.

Select Previous to return to last selected screen in screen flow.

Select Back to return to previous stage of the claim:

• from the Transaction Summary this will exit the claim and return to the Inbox
• select Process will return to the Transaction Summary (TS) screen
• select Assess will return to the Errors (SWE) screen

Reuse flags

These flags indicate whether an existing Treating Health Professional medical report (THP) or Care Needs Assessment (CNA) can be used for CP and/or CA. These display on relevant screens, for example:

• Adult Disability Assessment Summary (ADAS)
• Child Disability Assessment Summary (CDAS)
• Care Load Summary (CLS)

From CETS

To record details from a THP for:

• an adult care receiver, select ADAT - Disability Assessment Tool to view ADAS screen and proceed to:
• Adult Disability Management (ADMG)
• Adult Disability Behaviour (ADBH)
• Adult Medical Condition (ADMD)
• Adult Disability Personal Activities (ADPA)
• Adult Disability Cognitive Functions (ADCF)
  For more details about coding, see Coding the Adult Disability Assessment Tool (ADAT)
• a child care receiver, select CDAT - Child Disability Assessment Tool to view CDAS screen and proceed to:
• Child Medical Details (CDMD)
• THP Assessment Responses (CDTT)

For more details about coding, see Calculating the Treating Health Professional (THP) score for a child under 16 years on or after 1 July 2020.

To record details from a CNA, select from CETS:

• CLS - Care Load Summary to view CLS summary screen and to proceed via Next to:
• Care Load - Behaviour (CLBHA)
• Care Load - Behaviour (CLBHB)
• Care Load - Everyday Tasks (CLET)
• Care Load - Special Care Needs (CLSCA)
• Care Load - Special Care Needs (CLSCB)

CDCR - Care Details

• CRCI - Care and Institution Details. Care Receiver Determine Constant Care (CRCI) for CP claims
• For adult care receivers check RCA Institution Summary (RIS) screen. See Care receiver permanently enters or temporarily/permanently leaves an institution
• For multiple child care receivers, see Carer Payment (CP) (child) when caring for 2 to 4 children each with a disability or medical condition (combined care)
• CECS - Exchanged Care for CP (child) exchanged care
• CLCRF - Carers CSAT Referrals is used to refer a CP child claim to the Carer Specialist Assessment Team (CSAT)
• CRIA - Care Receiver Income and Assets. For non-customer adult and child care receivers. See Coding the Care Receiver Income and Assets (CRIA) 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 9
• No, go to Step 9

Select relevant screens:

• CPAS - Carer Payment Activity Summary if the carer is undertaking work, self-employment voluntary work, education or training activities when activity of 25 hours or more is coded, this will automatically update the BA screen with rejection reason 25H. If CPAS details are updated (care is met), delete the provisional rejection line on the BA screen
• CJAA - Carer Allowance Assessment History
• CJBA - Care Receiver Benefit Action. If carer was in receipt of Carer Allowance for the same care receiver previously, manually go to the CJBA screen in the carer's record and code the grant details. If rejecting, for example, FRC for a Carer Allowance claim, go to this screen and code the rejection details
• CDCA - Carer Allowance Combined Assessment. Update this screen if a child does not meet the required score to grant CA but the combined score of 2 children does. See Assessing a claim for Carer Allowance (CA) using the combined assessment scores of two children
• SCRA - Selection of Care Receivers for Assessment. The Selection Flag field must be ticked for the carer receiver to be included in the assessment. For claims assessed under combined care for 2 to 4 children, ensure all care receivers are included in the assessment. See Carer Payment (CP) (child) when caring for 2 to 4 children each with a disability or medical condition (combined care)
• CAATI - Carer Allowance Adjusted Taxable Income. Check that the current financial year income estimate is reasonable. See Carer Allowance income review processing and Carer Allowance (CA) income test - determining reference tax year and assessable income components
• ABSN - Absence Enquiry to record temporary cessation of care details for CP and/or CA

For information about the assessment, see:

• Assessment of income for Centrelink payments
• Assessment of employment income for Centrelink payments
• Assessment of assets for Centrelink payments

Is a property valuation required for the claim?

• Yes, it must be processed outside Process Direct:
• change the status of the claim to On Hold via the Status icon
• select on hold reason CR in Process
• set the On Hold Expiry Date to one week in the future or the due date following the allowed reasonable timeframe for return of requested documentation
• to request a valuation, the claim must be indexed in Customer First or Customer Record
• when the claim is indexed, to request the valuation, see Valuation of real estate and other assets
• No, go to Step 12

Note: when the valuation has been returned, the claim can be processed in PD.

This date determines what date the claim will be assessed from. The date is auto-based on the date the claim was submitted, recorded contact dates and the date the customer qualified for CP and/or CA.

The date can be changed by selecting the calendar icon and selecting the new assessment date. This can be more than 12 months in the past if necessary.

See Start Day.

See Table 6.

After saving updates, return to the Errors (SWE) screen to view errors, warnings and messages in the Message Log. These messages inform of the items that need to be addressed to prepare to finalise the claim.

If the AWE warning W223FY FTB estimate on FTI/FTF is not reasonable occurs during claim processing, contact the customer:

• get a reasonable family income estimate including their and/or their partner's income support payments
• the estimate must be updated in a standalone activity before finalising the claim or activity
• do not record in an income support new claim or activity a date of receipt that differs from the date the revised estimate is provided

Select Help at top right to launch the digital assistant (DA). Key the error message into the DA for help.

If contact with the customer is not successful see the Action needed when warning W223FY, estimate check edit E027FY or E135FI present table.

If edits and warnings present for Department of Veterans' Affairs (DVA) income or the carer has provided payments from the DVA:

• request a DVA clearance, then
• place the work item on hold

When all errors have been addressed, select Assess.

Check Entitlement details:

• Customer Reference Number (CRN)
• benefit status
• period end
• amount

Note: where the employment income coded for the initial entitlement period(s) is too high to grant CP from the start date, but the customer will become payable within 13 weeks of the date they lodged the claim, move the start date for CP on the PNA screen to the earliest Entitlement Period Start Date (EPSD) that the customer is payable from. This will prevent the claim from rejecting due to high income.

If customer's first entitlement period is short and employment income is recorded as LOP:

• check the EANS screen again after moving the start date
• when employment income is automatically reattributed on EANS, the customer may now be payable from an earlier EPSD. If so, readjust the start date on the PNA screen

If Process Direct adjusted the start date for CP and/or CA under intent to claim provisions but the Entitlement details do not show the claim is granting from that date:

• check if the customer has a later contact when they are qualified for CP and/or CA and
• if applicable, adjust the start date on the PNA or CJBA screen and DOC the reason for the decision

Service Officers may also need to manually stimulate payments on the RR screen. See the Earnings and Report Results (EARR) and Report Results (RR) screens table for more details.

Is the customer eligible for CP and/or CA?

• Yes, go to Step 3
• No, if necessary manually reject claim on the Benefit Action (BA) screen. Note: if the customer is claiming but not eligible for Carer Payment and they are eligible for Carer Payment (XWP), grant this instead. See Transfer from Wife Pension (WP) to Carer Payment (CP). Go to Step 11

Has the warning W039Dl - Carer Allowance may be payable displayed?

• Yes, go to Step 4
• No, proceed with claim

Check if the carer is eligible for Carer Allowance (auto).

Is the carer eligible for CA (auto)?

• Yes, go to Step 5
• No, go to Step 6

Where it has been established the carer is eligible for CA (auto):

• manually go to the Care Details (CDCR) screen
• key all required carer/care receiver details on the CDCR screen with the date of effect as the date CA (auto) is to be granted from
• before finalising the claim, check the Carer Allowance Action and Assessment Result (CJAA) screen displays CA being paid under the auto rules
• go back to the ELD screen

Check Entitlement details:

• Customer Reference Number (CRN)
• benefit status
• period end
• amount

Is CP and/or CA payable to the customer?

• Yes, go to Step 7
• No, and:
• CP is not payable due to income or assets but the customer will become payable within 13 weeks of the original claim date
  Change the Assessment Date on the PNA screen to the date the customer becomes payable. If employment income caused the rejection and has since reduced/ceased, change the date to the Entitlement Period Start Date (EPSD) of the first entitlement period where the customer is payable. See Start Day
• for all other reasons - reject the claim. If necessary, manually reject the claim on the Benefit Action (BA) screen. Go to Step 10

Before finalising the claim view rate details on:

• the Pension Rate Calculator (PRC), and
• Factors Affecting Rate (PFAR) screens

Check the expected results are reflected in the provisional data. Both provisional and before data displays so the changes can be identified.

If the carer is currently receiving Parenting Payment single (PPS) and working it may be more beneficial for them to stay on PPS. As the PPS income test is more generous than the single pension income test, the carer needs to make an informed decision about which payment they would like to get.

If the carer is being granted CP and/or CA after a rejected claim, go to Step 8.

If the carer receives Age Pension, lodges a claim for CP and meets the eligibility and payability criteria for CP:

Make genuine attempts to contact the carer by phone.

If customer contact is successful:

• discuss the benefits of each payment to determine if CP is still wanted
• see Transfers to Carer Payment (CP)

The carer must determine if they wish to remain on Age Pension (CP will be rejected) or transfer to CP (Age Pension will be cancelled).

Does the carer wish to transfer to Carer Payment?

• Yes, continue processing Age Pension to Carer Payment transfer. Record the details of the discussion and the decision made by the customer on a DOC
• No, code all available/updated information and reject CP manually via Benefit Action (BA) screen using rejection code Withdrawn/Voluntary surrender (CLR)
• Continue to process CA claim if applicable
• Record the details of the discussion and the decision made by the customer on a DOC
• See:
• Eligibility for Carer Payment (CP)
• Transfers to Carer Payment (CP) - the Resources page also has comparison information

If customer contact is unsuccessful:

• record details of each attempt to contact on a DOC, and
• process and finalise the claim to transfer from Age Pension to CP

If the carer receives DSP, lodges a claim for CP and meets the eligibility and payability criteria for CP:

• Make genuine attempts to contact the carer by phone:
• explain that any existing qualification and grandfathered status from their existing payment will cease once CP is granted
• discuss the benefits of each payment to determine if CP is still wanted
• explain if they choose to stay on DSP, the CP claim will be rejected Voluntary Withdrawal (CLR). If they later choose to transfer, they must submit a new claim (unless within 13 weeks of rejection)
• see Eligibility for Carer Payment (CP) and Transfers to Carer Payment (CP)

If genuine contact attempts by phone are unsuccessful:

• send a Q164 letter to the carer to request contact
• record details in the claim progress Note or DOC on the carer’s record, including:
• contact attempts made
• if the carer calls, discuss with the customer DSP to CP and the benefits of each payment. The carer must determine if they wish to remain on DSP (CP will be rejected) or CP (DSP will be cancelled)
• Service Officers must record details on a DOC of the discussion with the customer including the decision on which payment they prefer

Hold the claim for the required response time.

When the claim has come off hold:

• Carer has contacted and wishes to continue with CP claim: continue processing DSP to CP transfer. Process any CA claim as required
• Carer has contacted and wishes to remain on DSP: code the CP claim and reject using rejection code Withdrawn/Voluntary surrender (CLR). Process any CA claim as required
• Carer has failed to contact: reject the claim Failed to Reply to Correspondence (FRC), see Rejecting a Carer Payment (CP) claim. Customer will remain on DSP. Process any CA claim as required
• Carer requested to withdraw their CP claim: Withdrawal of claims. Customer will remain on DSP. Process any CA claim as required

If the carer receives an ISP, such as Jobseeker Payment (JSP), or Parenting Payment (PP), a Benefit Transfer occurs within the new claim activity.

This:

• cancels the current payment
• grants CP for the period of entitlement, and
• pays the calculated amount of arrears for CP (less any of the losing payment received for the same period)

Service Officers must:

• make sure the arrears of CP exceed the amount of the losing payment paid for the period of entitlement. If this does not occur, get Local Peer Support (LPS) and/or Service Support Officer (SSO) help. If needed, send a request to the Level 2 Policy Help Desk with arrears and error details
• if CP entitlement ceased before the date of claim processing, make sure there is no overpayment from the date CP entitlement was lost (cancellation date) to the date CP claim was processed
• check the Tax Payment Summary (TXGS) screen to see if the customer had tax deductions taken from the losing payment:
• When processing a retrospective benefit transfer, refund any tax deducted from the losing payment in the current financial year to the customer. See Refunding Australian Taxation Office (ATO) excess tax deductions

If a customer claims CP or CA and they qualify for the other payment, Service Officers must contact the customer to tell them of their eligibility to the other payment.

If the customer is:

• available to complete the claim now, run ACC with them
• unavailable to complete the claim now, or contact was unsuccessful
• send the customer a letter inviting them to claim. See Creating a Q999 or Q888 letter

Record details on a DOC on the customer's record, include if:

• contact was successful/unsuccessful,
• ACC was not run and why, or
• an invite letter was sent

If granting payment after a claim rejection check the following is still accurate:

• the carer's income and assets and
• the care provided to the care receiver

If not, get current details either verbally or in writing. To decide if new information is needed, consider:

• processing time between the initial claim and the date the claim
• if the claim is for CP, CA, or a combined claim
• if the carer is in receipt of another income support payment
• income of customer and their partner (if applicable) at the time of claim and whether these are ongoing
• the assets of the customer and their partner (if applicable) at the time of claim
• the likelihood of the customer returning to the workforce (employment or self-employment)
• the likelihood of the care receiver leaving the carer's care or going into hospital or respite occurring
• the likelihood of the care receiver's carer score or THP score reducing. If so, the impact on the ADAT or DCLAD
• any relevant factors

Is the claim a combined CP and CA (child) claim that will result in CP (child) granting and CA (child) rejecting?

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

Where the claim a combined CP and CA (child) claim that will result in CP (child) granting and CA (child) rejecting the carer may be eligible for CA (auto), see Eligibility for Carer Allowance (CA) (auto) when a carer is also receiving Carer Payment (CP) (child).

Is the CP (child) customer eligible for CA (auto)?

• Yes, go to Step 11
• No, go to Step 12

Where the combined CP and CA (child) claim will result in CP (child) granting and CA (child) rejecting and the carer is eligible for CA (auto):

• do not finalise the combined CP and CA claim
• cancel the combined claim
• process the CA claim as an individual claim for CA (child)
• finalise the rejection of the CA (child) claim. Do not inhibit the rejection letter

On the following day:

• process the CP (child) component of the claim
• once on the ELD screen, manually go to the Care Details (CDCR) screen
• key all required carer/care receiver details on the CDCR screen with the date of effect as the date CA (auto) is to be granted from
• before finalising the claim, check the Carer Allowance Action and Assessment Result (CJAA) screen displays CA being paid under the auto rules
• go back to the ELD screen

Go to Step 12

Is the claim resulting in a JSP to CP transfer where a change in circumstances results in CP cancelling within the new claim activity?

• Yes, go to Step 13
• No, take the following action to finalise the claim:
• If any manual adjustments are required, to adjust debt details, go to the Assessment Consequences (ASC) screen and to adjust arrears, go to the Daily Rate Component (RAC) screen
• Select Finalise
• Update the claim outcome DOC with the relevant payment and claim outcome and select Finalise
• Procedure ends here

Note: if a customer has received Crisis Payment and a change has occurred, a manual reassessment of Crisis Payment may be required. For more information, see Reviewing and reassessing Crisis Payment (CrP).

Where a carer was in receipt of JSP on the day the CP claim is processed, and the claim results in a JSP to CP transfer, and a change in circumstances results in CP cancelling in the new claim activity the following action is required:

• Finalise the claim:
• If any manual adjustments are required, to adjust debt details, go to the Assessment Consequences (ASC) screen and to adjust arrears, go to the Daily Rate Component (RAC) screen
• Select Finalise
• Update the claim outcome DOC with the following:
• relevant payment
• CP claim outcome (grant)
• CP is cancelling within the new claim activity
• select Finalise
• Create a DOC for CP cancellation, noting this occurred within the CP new claim and will be referred to the level 2 Helpdesk to have JSP reinstated
• Refer the case to the Level 2 Policy Help Desk to have JSP payment reinstated

Note: for any other payment types, contact the  Level 2 Policy Help Desk.