QOL and QMA dispute processes for face to face, smart centre, Service Delivery Partner and CAO staff 111-21112956

Question

Answer

What does the status mean?

• New: this is the initial status of new disputes
• Under review: a request has been assigned to an Independent Reviewer and is being reviewed
• Under review pending advice/clarification - the Independent Reviewer is seeking advice/clarification
• Awaiting reply: the Independent Reviewer is waiting for the original QOL checker's/QMO's right of reply
• Reply received: the original QOL checker's/QMO's reply has been received
• Escalated: the dispute has been referred to a program, policy team or Level 2 Helpdesk
• Withdrawn: the dispute has been withdrawn
• Finalised: the dispute has been finalised

What does the dispute outcome mean?

• Pending: the dispute is still under review
• Upheld: the Independent Reviewer agrees with original check result
• Upheld for a different reason: the checking outcome is correct but for a different reason to the original decision
• Overturned: the Independent Reviewer agrees with the dispute
• Activity not located: the activity or Work Item was unable to be located
• Insufficient evidence: insufficient evidence to support the QOL/QMA dispute has been provided
• Non proficiency impacting error - the error/s do not affect overall accuracy and cannot be disputed
• Withdrawn - the dispute has been withdrawn

How do I edit my dispute?

Staff can update a QOL/QMA dispute after it has been lodged.

Is the status of the dispute New?

• Yes:
• Select Edit. Open the SSW QOL and QMA Dispute Form
• Read and acknowledge the Privacy statement
• Make the required updates
• Scroll to the bottom of the form and select Update
• No:
• Select Edit. Open the SSW QOL and QMA Dispute Form
• Contact the Independent Reviewer to update the dispute
• If the Independent Reviewer is not available, email SSW Quality Team

How do I withdraw a dispute?

Staff can withdraw a QOL/QMA dispute after it has been lodged.

For the process, see the Process page:

• Face to face and smart centre - Table 1 Step 7
• Service Delivery Partner - Table 3 Step 5
• Complex Assessment Officer (CAO) - Table 5 Step 6

When will I be notified of the dispute outcome?

When the dispute is finalised, the staff member and their Team Leader receive an automated email.

Who is notified when the original checker's decision is overturned and the dispute is finalised?

An automated email is sent to:

• the original checker
• the staff member who lodged the dispute and their Team Leader

Who is notified when a dispute is referred to an independent reviewer?

• An automated email is sent to the original checker
• The staff member who lodged the dispute and their Team Leader receive an automated email when the dispute is finalised, including the response from the Independent Reviewer (if relevant)

Can I seek a further review if I disagree with QOL/QMA dispute decision?

No, when the QOL/QMA dispute decision is finalised, no further escalation steps are available.

How long does it take for finalised overturned decisions to update in SmartTools?

If the check was completed:

• within the last 28 days - updated daily
• between 29 to 90 days ago - updated weekly on the weekend
• 91 or more days ago - SmartTools will not be updated

Staff members overturn does not appear in SmartTools. What can they do?

Follow up with the Team Leader to complete all basic troubleshooting before escalating further. This includes:

• The SharePoint entry has a finalised status of Overturned
• The Service Officer and QOL checker/QMO logon IDs are correct
• The date the activity was sampled or submitted matches the information in:
• QOLCheck/QOLStat
• Work Optimiser, and
• the date of the returned activity in SmartTools
• The Activity (AMR) number matches the QOL activity:
• Example 1: AMR: 1234 (correct)
• Example 2: AMR: amr 1234 (will not match)
• The Work Item ID matches the QMA:
• Example 1: Work Item ID: 12345678 (correct)
• Example 2: Work Item ID: claim id 12345678 (will not match)
• The correct benefit status is entered

If all the above information matches correctly, email the SSW Quality Team and confirm all above information is correct by including a 'snip' of all screens:

• Smart Coach 'Daily' view
• QOL tool or QMA feedback, and
• SharePoint entry

Type of feedback

Text

Feedback included missing or incorrect resources to support the decision

Choose the most appropriate text from the following (more than one may apply):

• Incorrect and/or insufficient resources provided to support error/return
• Resource should have been xxxxx
• No resource quoted, should have been xxxxx

Explanation of the error and/or corrective action not sufficient

Feedback did not clearly describe the error and/or corrective action taken/required

Feedback not clear or inappropriate

Feedback was difficult to understand, or did not meet the Feedback Policy