Preparing, quality and peer to peer checking of Medicare external mail 111-23101138

Team Leaders:

• will get an email notification when a checking result is recorded for a staff member in their team, and
• must reassign outstanding corrections for staff during unplanned leave

Letters must be checked by a nominated Quality Checker.

Quality Checkers must be:

• a Service Officer (SO4/SO3) nominated by a Team Leader
• a delegate (if specifically outlined by a business area or Team Leader), or
• where a letter contains free text, a Team Leader, Service Centre Manager, or delegate

Staff must not quality check their own work or ask peers (not nominated by a Team Leader), to perform checks.

All Quality Checkers must:

• complete the peer to peer check by following the peer to peer check guidelines
• record an outcome using the appropriate tool, see Letter checking - My Items
• where errors have been identified, delete the letter from the P2P secure folder. See Using Standard Letter Templates (SLT) or Digital Messaging Capability (DMC) to create manual letters
• perform a quality check on letters for that day based on business line requirements

Note: staff working from home, must follow Using Standard Letter Templates (SLT) or Digital Messaging Capability (DMC) to create manual letters.

To prepare for coaching, Team Leaders must monitor staff proficiency by monitoring results in the Health Letter Checking Dashboard regularly or at minimum, each Settlement Period.

If proficiency criteria of:

• 95% for all/any 20 consecutive letters (not containing free text) submitted is achieved:
• record proficiency outcome in Smart Coach under conversations and in the relevant coaching notes
• notify the staff member of the proficiency outcome
• 95% for all/any 20 consecutive letters submitted is not achieved:
• continue to monitor the results using the Health Letter Checking Dashboard
• tell the staff member to continue to submit the letters as required, until they obtain proficiency

Note:

• free text letters are not included when calculating staff peer to peer letter proficiency
• free text letters must continue to be checked regardless of staff proficiency status
• Team Leaders can reset a staff member's proficiency status if they identify a learning need. Go to Step 3
• letters checked during consolidation will not contribute to letter proficiency. Staff letter proficiency is determined post consolidation

A Team Leader can determine that a staff member's proficiency needs resetting because of a learning need.

To do this:

• Notify the staff member to restart submitting letters for peer to peer checking. Once an error is recorded for a letter that does not contain free text, a staff member's proficiency will be amended in the Health Letter Checking Dashboard
• Record the proficiency outcome in Smart Coach under conversations and in the relevant coaching notes

Note: proficient staff trained in a new program/skill will have letters checked during consolidation only. A new skill does not automatically reset peer to peer proficiency.

Where a staff member raises a dispute about the outcome of a peer to peer letter check, the Team Leader must:

• discuss the feedback with the staff member and onsite Local Peer Support (LPS) to resolve the dispute
• email all details to the relevant Program area (Health Service Delivery Division (HSDD) - Program areas) when a dispute is not resolved onsite for a HSDD staff member. Face to face Team Leaders email all details to the Medicare National Portfolio - Face to Face team when a dispute is not resolved onsite for a face to face staff member
• tell the staff member about the outcome of the dispute once resolved

Successful dispute outcomes

• HSDD Team Leaders:
• email the Health Service Delivery Division Quality Performance and Technical Support team with:
  relevant details of the letter
  staff member's logon details, and
  Quality Checker's logon details
• and staff member will get an automated email with the updated outcome
• will get a reply from the Quality team once actioned
• Face to face Team Leaders:
• email the Medicare National Portfolio - Face to Face team with:
  relevant details of the letter
  staff member's logon details, and
  Quality Checker's log on details
• and staff member will get an automated email with the updated outcome

This process applies to all manual letters subject to peer to peer checking, including letters with free text.

It does not apply to the following letters:

• Submitted for quality checking via PaNDA. For example:
• Lifetime Health Cover (LHC)
• Statement of Benefit (SOB)
• Debt letter - Overpayment over $100
• Estimate, or
• LHC and SOB letter requests from a customer attending a service centre
• Sent for delegation in PaNDA. For example:
• Out of Home Care (OOHC)
• Provider Registration
• Pathology
• Location Specific Practice Number (LSPN) delegation
• Free text for Letters for Practice Incentives Program (PIP) and Workforce Incentive Program (WIP) - Practice Stream
• Free text for Disaster Health Care Assistance Scheme eligibility criteria and document requirements
• The Provider Registration Update Spreadsheets for non-Australian Health Practitioner Regulation Agency (Ahpra) registered allied health providers
• Aged Care and Pharmaceutical Benefits Scheme (PBS)
• Those prepared by staff during training or in consolidation

After preparing the manual letter, identify if the letter type is subject to peer to peer or free text checking.

Is the letter type subject to peer to peer or free text checking?

• Yes, go to Step 2
• No, follow the letter checking process relevant to the letter type prepared (if applicable). Procedure ends here

Staff must:

• check their proficiency regularly by using the Health Letter Checking Dashboard
• once they have achieved proficiency, only submit free text letters for checking
• refer any dispute over the checking outcome to a Team Leader to resolve

For more details on secure folders and working from home, see Using Standard Letter Templates (SLT) or Digital Messaging Capability (DMC) to create manual letters.

If the staff member is:

Does the letter include free text for checking?

• Yes, send a free text letter to the nominated Quality Checker for checking, (see Table 1 about nominated Quality Checkers)
• No:
• Print and issue the letter to the customer/provider via the appropriate channel. Use windowed envelopes when posting letters
• if applicable, record a note in PaNDA, 'Letter printed and issued to customer on (date)'
• Procedure ends here

For more details on secure folders and working from home, see Using Standard Letter Templates (SLT) or Digital Messaging Capability (DMC) to create manual letters.

Send all letters for checking (see Table 1 about nominated Quality Checkers).

Staff must:

• Merge the letter and any additional documents into a single PDF. For more details on merging documents and naming conventions, see Using Standard Letter Templates (SLT) or Digital Messaging Capability (DMC) to create manual letters
• Save the letter to their team's secure folder Customer Information
• Include "email'' in the file name at the end of the naming convention, for electronically sent letters. For example, letters sent electronically through HPOS or email
• If applicable, upload the letter to PaNDA and leave the work item status as Open
• Move the letter to the secure folder P2P

Note: each team has a P2P folder in their Customer Information folder used for peer to peer letter checking.

The staff member will get an email detailing the outcome of the letter check. They must wait for this prior to finalising their work item.

Staff must refer to the feedback email for the outcome of the peer to peer check.

Has an error been identified?

• Yes:
• Generate a new letter with the correct details
• Refer the letter again for peer to peer checking
• No, finalise the work item in PaNDA:
• For letters sent electronically, for example, through HPOS or email, staff must:
  Pick up the checked letter from the 'Email' folder, and
  Attach and finalise through the relevant channel. Each team has an Email folder in their Customer Information folder used for peer to peer letter checking
• All other manual letters will be printed by the Quality Checkers

The nominated Quality Checker must complete the peer to peer check by following these guidelines.

Retrieve the letter from the secure P2P folder in the team’s secure Customer Information folder.

Note: each team has a P2P folder in their Customer Information folder used for peer to peer letter checking.

Check the following details in the letter:

• Date
• Recipient's name and address match relevant database, for example, CDMS or PDS or nominated address on application form
• Must be addressed in line with Australia Post standards
• Reference - Letter templates for each program may be designed differently to cater for specific system requirements of each program.
  For example, PaNDA work ID where work type is completed in PaNDA.
  For digital Medicare enrolments, use the Digital Medicare enrolments (DME) application ID.
  When no other reference details are available, use a staff member's Source Office Code
• No personal information unless it is relevant to the claim or application. For example, a date of birth should not show on an itemised claim statement sent to a customer
• Address is visible or, where a windowed envelope cannot be used, details on the envelope match the details on the written correspondence
• For use of free text, make sure the content is accurate in following the business line's policies and procedures. The content must provide clear instructions for a customer to perform any required follow-up correspondence
• Additional documents, as required, that are associated with the claim or application, for example, return of customer information:
• check that another customer's documents have not been attached or merged in error, and
• ensure all relevant documents have been included
• Signature of the staff member responsible for preparing the correspondence if required as per business area processes
• Formatting of the letter, for example, fonts, spacing, indents, logo - Services Australia logo must not be blurry

The Resources page has links to the Writing Guide and mandatory standards for letters, emails, and SMS.

Go to Step 4.

The Quality Checker must record all results in the Letter Checking SharePoint Tool - New Item.

To do this, open the Letter Checking SharePoint Tool:

• Select New item
• Record all mandatory fields (mandatory fields are marked with a red asterix *)
• SO Logon/Name: Search by logon or Surname, First Name
• Select Find Letter button: From the dropdown menu select the letter type being checked
• Reference ID: Where available this might be:
• the PaNDA Work Item ID
• a reference number relevant to the work type, or
• the name of the file
• Is this an Electronic Letter: If the letter submitted for checking is an electronic letter the naming conventions of the file will include 'Email' at the end.
  Select Yes which will indicate to the staff member that the electronic letter has been checked and requires them to attach it to their email for finalising
• Is this a Free Text Letter: Select Yes if this is a free text letter
• Has Free text Letter been printed: If printing the free text letter, select Yes
• Check Outcome radio button: Select:
• Error - where an error has been identified, then select the reason for the error, or
• Error Free - to show the letter has no identified errors, or
• Feedback: Use to record any other details relevant to the staff member. Do not include details which identifies the customer, such as name, date of birth and Medicare card number

The staff member and their Team Leader will get an automated feedback email about the outcome. The field indicating if a letter contains free text or not must be recorded correctly. This field is used to determine if a letter will be included in a staff member's proficiency calculation.

Note: for any corrections needed after submitting results in the Letter Checking SharePoint tool, for:

• HSDD Checkers, email the Health Services Deliver Division Quality Performance and Technical Support Team
• Face to face checkers email the Medicare National Portfolio - Face to Face. The staff member and Team Leader will get an automated email with the updated outcome

Has an error been identified?

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

If the Quality Checker identifies errors, they must:

• Record details of the error in the Feedback field on the Letter Checking SharePoint Tool and select Submit.
  For example, record any other details relevant to the staff member. Do not include details which identifies the customer, such as name, date of birth and Medicare card number
• Delete the letter and any additional documents from the P2P secure folder

Procedure ends here.

The Quality Checker must record the result on the Letter Checking SharePoint Tool, and select Submit.

For face to face staff in a service centre - if quality checking a hard copy of a letter for work types not completed in PaNDA, after recording the result, go to Step 8.

Is the checked letter being sent electronically?

• Yes, the Quality Checker will move the letter from the P2P folder to the 'Email' folder. Procedure ends here
• No, go to Step 7

Is the Quality Checker working from home?

• Yes:
• Move the letter to the secure Print folder in the team's Customer Information folder
• Note: each team has a Print folder in their Customer Information folder used for staff working from home. The nominated printer person in the team prints the letter. See Using Standard Letter Templates (SLT) or Digital Messaging Capability (DMC) to create manual letters
• Procedure ends here
• No, the Quality Checker must:
• Print the letter
• Envelope the letter and place in the mail tray
• Delete the letter from the P2P secure folder
• Procedure ends here

A copy of the quality checked letter must be:

• signed and dated by the Quality Checker, and
• kept in the staff member's daily batch

This is an extra copy of the letter sent and is required for all letters where the work type is not completed in PaNDA.

For more details about filing and batching archiving procedures, see Archiving and document retrieval for Medicare.

Staff must:

• create the relevant work item
• upload a new work item in PaNDA
• select from the drop down menu:
• Program: Miscellaneous'
• Worktype: Public QOL letters

See also: Create new work items - PaNDA Document Upload.

Complete the following in PaNDA:

• key Medicare number in the Medicare Number field
• key Surname First Name in the Surname First Name field
• select Upload Document
• status as Open
• delete the document from the secure folder after successful upload

Do not select the Assign to me on creation check box, unless uploading more than one document.

To upload additional documents:

• select the Assign to me on creation checkbox. Selecting the checkbox:
• assigns the work item to the user, and
• shows the work item in Worklist
• upload the additional document and add comments 'uploaded additional documents and item unassigned for checking'
• make sure the status of the work item is Open
• unassign the work item to return it back to the Public QOL letter pool for checking

See also: Processing and National Demand Allocation (PaNDA).

If the quality check outcome is:

Staff will not get an email from the Quality Checker.

The Quality Checker will print and post the letter to the customer.

• The Quality Checker will correct the error/s, print, and post the letter to the customer
• The staff member's Team Leader will get feedback via the Staff Feedback Tool
• Staff must review the feedback received and refer to the letter in the PaNDA folder (when required)

See also: Management of the Staff Feedback Tool.

Choose the relevant option:

Staff must:

• create the relevant work item
• upload a new work item in PaNDA
• select from the dropdown menu:
• Program: Miscellaneous
• Worktype: QOL PC Adjustment Letters

See Create new work items - PaNDA Document Upload.

Complete the following in PaNDA:

• key Medicare number in the Medicare Number field
• key Surname First Name in the Surname First Name field
• select Upload Document
• leave the status as Open
• delete the document from the secure folder after successful upload

Do not select the Assign to me on creation checkbox, unless uploading more than one document.

To upload additional documents:

• select the Assign to me on creation checkbox. This will:
• assign the work item to the user, and
• show the work item in Worklist
• upload the additional document and add comments 'uploaded additional documents and item unassigned for checking'
• leave the work item status Open
• unassign the work item to return it back to the QOL PC Adjustment Letters pool for checking

See Table 2, Step 8 in Latter day adjustments (LDA) and HELD payments for patient claims:

• Print/upload the Mainframe overpayment screen to PaNDA
• Complete the Debt Advice Notice (DAN)
  Note: the Resources page of Latter day adjustments (LDA) and HELD payments for patient claims has a link to the DAN
• Complete the Patient Claim Adjustments Recovery over $100 letter
• Add a processing note to the PaNDA record
• Re-categorise the PaNDA work item to MISC_ QOL PC Adjustment Letters
• Leave the work item status Open

See Processing and National Demand Allocation (PaNDA).

If the quality check outcome is:

Staff will not get an email from the Quality Checker.

The Quality Checker will:

• print and post the SOB letter to the customer
• for Debt letter - Overpayment over $100:
• email a copy of the Mainframe Overpayment screen, DAN, and recovery letter to the Medicare Debt Recovery Team - this team issues recovery letters and invoices to debtors
• cc the processing staff member and their Team Leader into the email
• See Table 2, Step 8 in Latter day adjustments (LDA) and HELD payments for patient claims for LDA and HELD payments
• close the PaNDA work item

The Quality Checker will:

• correct the errors then print and post the SOB to the customer
• for Debt letter- Overpayment over $100:
• correct the errors, and
• email all relevant documents to the Medicare Debt Recovery team - this team issues recovery letters and invoices to debtors, and
• cc the processing staff member and their Team Leader into the email
• close the PaNDA work item
• the Quality Checker will send the staff member feedback via the Staff Feedback Tool

The staff member's Team Leader will get feedback via the Staff Feedback Tool.

Staff must review the feedback received and refer to the letter in the PaNDA folder (when required).

See Management of the Staff Feedback Tool.

The Quality Checker must:

• select Ready at the bottom right of the Worklist screen to get a new work item in Work Optimiser
• quality check the relevant work item

See Managing work using the Worklist.

Note: the Quality Checker must refer to the relevant Program/Policy escalation process in Operational Blueprint if they need technical help.

If the quality check outcome is:

Quality checker must:

• print and post the letter to the customer - Lifetime Health Cover (LHC), Statement of Benefit (SOB) and Estimate
• key comments in PaNDA - 'QC error free - Letter printed and posted to customer on (date)'
• close the PaNDA work item
• for Debt letter - Overpayment over $100:
• email a copy of the Mainframe Overpayment screen, DAN, and recovery letter to the Medicare Debt Recovery Team - this team issues recovery letters and invoices to debtors
• cc the processing staff member and their Team Leader into the email
• see Table 2, Step 8 in Latter day adjustments (LDA) and HELD payments for patient claims for LDA and HELD payments

Quality Checker must:

• resolve the error/s and upload the new letter to the existing work item. Include comments in CDMS/PaNDA as per business rules
• for LHC letters created in the MEE Portal:
• correct the error in CDMS
• go to the customer’s DME application in the MEE Portal and create a LHC letter in the MEE Portal. See Table 5 in Digital Medicare enrolments (DME) and the MEE Portal
• if there is a system issue, see Tier 0 technical support - self sufficiency and report the issue using the Medicare online account (MOA) and digital Medicare enrolments (DME) general enquiries issues mySupport form. The Resources page has a link to the form. Create the LHC letter using the Standard Letter Template (SLT) or Digital Messaging Capability (DMC) to create manual letters
• delete the incorrect letter from the existing PaNDA file
• delete the document from the secure folder after successful upload
• key relevant comments in PaNDA about the error/s identified
• print and post the letter to the customer - LHC, Estimate and SOB
• key comments in PaNDA 'Letter printed and posted to customer on (date)' - LHC, Estimate and SOB
• for Debt letter - Overpayment over $100:
• correct the error
• email all the relevant documents to the Medicare Debt Recovery team - this team issues recovery letters and invoices to debtors
• cc the processing staff member and their Team Leader into the email
• see Table 2, Step 8 in Latter day adjustments (LDA) and HELD payments for patient claims for LDA and HELD payments
• close the PaNDA work items
• submit feedback via the Staff Feedback Tool:
• select Service details > Medicare > Medicare Customer - select C&A patient claims for SOB, Debt letter - Overpayment over $100 and Estimate letters, select MEE for LHC letters, and
• include relevant Operational Blueprint links

Note: if a letter generates from an existing work item, make sure the correct letter is also uploaded to the original work item. Add comment ‘QC completed - uploaded correct letter.'

A Quality Checker (a delegate if specifically outlined by a business area/Team Leader or a nominated Service Officer (SO4/SO3) must check letters to ensure compliance with Services Australia guidelines.

The Quality Checker:

• is a peer nominated by a Team Leader
• must perform a daily quality check on correspondence for that day based on business line requirements

Quality checking will make sure that the delegate confirms the correspondence goes to the intended and authorised customer, as per business area procedures.

Staff must not perform quality checks on their own work.

After creating and saving the LHC and SOB letter in the secure Customer Information folder in their team's secure shared drive, staff must ask the Quality Checker to check the letter.

The face to face Quality Checker must:

• Quality check the copy of the LHC and SOB letter from the secure Customer Information folder in their team's secure shared drive
• Check the correspondence details

The Resources page has links to the Writing Guide and mandatory standards for letters, emails, and SMS.

If the quality check outcome is:

Quality Checker must:

• Give feedback to the staff member who prepared the letter
• Print the letter to hand to the customer
• Upload a copy of the letter to PaNDA and close the work item (see below)
• Delete the document from the secure folder after successful upload

Quality Checker must:

• Give feedback and ask the staff member to resolve the error and resubmission as required
• Delete the document from the secure folder after successful upload
• Submit feedback via the Staff Feedback Tool:
• select Service details > Medicare > Medicare Customer - select MEE for LHC letters, and C&A patient claims for SOB
• include relevant Operational Blueprint links
• upload the correct LHC or SOB letter to PaNDA and close the work item (see below)

See Create new work items - PaNDA Document Upload.

Quality Checker must:

• Create the relevant work item
• Upload a new work item in PaNDA
• Select from the dropdown menu:
• Program: Miscellaneous
• Worktype:
  LHC: Public QOL letters, and
  SOB: QOL PC Adjustment letters
• Complete the following fields in PaNDA:
• Key the Medicare number in the Medicare Number field
• Key surname and first name in the Surname First Name field
• Select Upload Document
• Select the Assign to me on creation checkbox
• Key comments in PaNDA "P2P QC completed"
• Close the PaNDA work item
• Delete the document from the secure folder once upload is successful