Assessing Commonwealth Seniors Health Card (CSHC) claims 065-06030000
This document outlines information about assessing Commonwealth Seniors Health Card (CSHC) claims.
Checking customer details and the claim
Step |
Action |
1 |
Locate claim + Read more ... For claims, request or search for the claim work item via Inbox. Select the work item to view the Customer and Activity Information table on the Transaction Summary (TS) screen. For new claims, Service Officers must stream the claim on the day allocated and a progress of claim note must be created and/or updated, if the claim cannot be immediately finalised. See the Progress DOC for details. Has the claim been previously streamed? |
2 |
Claim status + Read more ... The claim status must be In Process before it can be processed. Is the claim status ‘In Process’?
Note: the claim should not be re-opened until the customer provides all requested information. |
3 |
Review claim details in Process Direct + Read more ... Check the customer's benefit status line. If the customer's benefit status is SHC/CUR indicating that the claim assessment has already been completed, update the claim status to Not Required via the Status icon. Procedure ends here. To review the information provided by the customer in the online claim or ACC:
To view paper claims and scanned supporting documents:
Check the date the document was scanned. There may also be older documents not related to the claim. Check customer tasks, DOCs and Notes by selecting the relevant icons. |
4 |
Type of CSHC Claim + Read more ... Check the type of CSHC claim that has been allocated CSHC online/ACC claim
Service Officers must check the date of submission and if necessary, correct the Date of Receipt (DOR). See Table 2, Step 11 in Viewing and processing online and Assisted Customer Claim (ACC). Combined partner online claim
Paper claim (SA296 or SA296a)
Note: if CSHC claimant is partnered but the partner has not also claimed CSHC (including as part of a combined partner claim online or paper), their partner may also be eligible for CSHC or another service.
|
5 |
Intention to claim for vulnerable customers + Read more ... If the customer has indicated in the claim they are in a crisis this can be confirmed by checking the:
Pre-Claim Vulnerable Circumstance (PRECLM) screen |
6 |
Check Customer Details + Read more ... Service Officers must check the claim details to make sure the existing customer details are correct. If the customer:
|
7 |
Relationship Details + Read more ... These details must be reviewed/updated before processing the claim. On the TS screen:
|
8 |
Qualification on date of claim + Read more ... On the day the claim was lodged was the customer Age Pension age?
Note: early claim provisions do not apply to the CSHC. If the person is not qualified for CSHC on the date of claim lodgement the claim must be rejected. A request for information should not be issued if the claim will be rejected, unless it is going to change the outcome of the claim. |
9 |
Residence requirements + Read more ... On the day the claim was lodged, does the customer satisfy the residence requirements?
|
10 |
Customer located in Australia + Read more ... Check if the customer was physically present in Australia on the date they lodged their claim. Check the customer's travel movements (if available) using:
On the day the claim was lodged, is there evidence that the customer was not in Australia?
|
11 |
Customer receives a pension or allowance + Read more ... On the day the claim was lodged, was the customer in receipt of a Social Security pension or benefit?
|
12 |
Customer receives a DVA pension or allowance + Read more ... Check if on the day the claim was lodged if the customer was in receipt of:
See Payments from the Department of Veterans' Affairs (DVA) and referrals to the DVA Clearance Team for more information. On the day the claim was lodged, was the customer in receipt of a DVA pension or allowance?
|
13 |
Identity Confirmation + Read more ... The claimant must meet the Identity Confirmation requirements. Identity Confirmation for a partner is only needed if the partner is also applying for CSHC. Check the customer's Identity Status under the Snapshot icon in Process Direct. Has the customer met the Identity Confirmation requirements?
|
14 |
Tax File Number (TFN) + Read more ... Has the customer provided their (and their partner's) Tax File Number (TFN) (unless an exemption is granted)?
|
15 |
CSHC income test + Read more ... Has the customer declared Adjusted Taxable Income (ATI) for the reference year less than the Commonwealth Seniors Health Card (CSHC) - Taxable Income Limit?
|
16 |
Evidence of income + Read more ... Has the customer provided the required evidence of income?
|
17 |
Required information for online claims + Read more ... Has the customer submitted an online claim with all the required information?
Update the Progress of claim Note/DOC or where a progress of claim DOC is required, create a Fast Note - select Auto Text, use Older Australians > Claims > Progress of AGE/SHC/PDB claim. (Edit to remove the AGE/PDB) Check the claim status and if required manually change to On Hold - Customer to Provide Information through the Status icon with a due date after the allowed time. Note: when assessing a combined partner online claim or a joint paper claim where a request for information is required then it should be issued to both customer and partner Procedure ends here until:
|
18 |
Required information for paper claims + Read more ... Has the customer provided a completed claim with all the required information?
Note: when assessing a combined partner online claim or a joint paper claim where a request for information is required then it should be issued to both customer and partner. Procedure ends here until
|
19 |
Referrals + Read more ...
Is a specialist referral required?
|