Assessing claim for Pensioner Education Supplement (PES) 010-05040020

A claim work item is created for allocation and processing in Process Direct where a customer submits:

• an online claim
• an Assisted Customer Claim (ACC), or
• a Claim for Pensioner Education Supplement (SY004) paper claim
• an Information required for continuation of Pensioner Education Supplement or ABSTUDY (SY075) form being used as an abridged claim

Paper claims for PES will create an automatic Social Online Application (SOA) shell in Process Direct. These are processed the same as an online claim. When a SOA shell is automatically created for a paper claim no details will display.

If a paper claim (SY004/SY075) has been lodged but no SOA shell is auto created, create a manual SOA shell by using the SOA Shell application in Process Direct.

On the Claim Application page, a new Claim ID will display and the claim is ready for processing.

If the customers previous claim is rejected (REJ) and a decision is made to reassess their entitlement, re-index the claim.

Go to Step 2.

If the customer is receiving:

• JobSeeker Payment (JSP) or Youth Allowance (YA) (job seeker), go to Step 3
• Parenting Payment Partnered (PPP) or Disability Support Pension (DSP) transition group, go to Step 4
• a qualifying payment for PES, or claiming a qualifying payment go to Step 5
• a qualifying payment for PES because of a benefit transfer and the PES claim was submitted prior to transfer date, go to Step 7
• a Department of Veterans Affairs (DVA) payment, go to Step 5
• ABSTUDY Incidentals only, on EDCH the Participation Status field displays PTS or FTI, go to Step 8
• ABSTUDY PES, they do not qualify for PES under the multiple entitlement exclusion rules. To transfer to PES, see Processing transfers to Pensioner Education Supplement (PES) from ABSTUDY PES to receive Education Entry Payment (EdEP). If the ABSTUDY PES has:
• been cancelled, see Table 2
• not been cancelled, reject the claim, see Table 3

If the customer:

• Is a JSP principal carer, go to Step 5
• Is receiving:
• JSP and is not a principal carer, or
• Receiving Youth Allowance (job seeker) and they have started a new course, or
• had a break in study and lodged a new claim for PES, they do not qualify for PES. Reject the claim. See Table 3
• was in receipt of PES immediately before transferring to JSP or YA (job seeker) and they are claiming PES within 14 days of its cancellation, restore the PES payment. Procedure ends here.

Is the customer receiving PPP because they are in the DSP transition group and transferred to PPP and have a partial capacity to work?

• Yes, go to Step 5
• No, the customer does not qualify for PES as they are re-commencing a course of study or commencing a new course, reject the claim. See Table 3

To qualify for PES, the customer must:

• be of PES age
• meet the PES residence requirements
• receive a qualifying payment for PES

If a customer is waiting for approval of a PES or ABSTUDY PES qualifying pension or payment determine if the customer meets all other eligibility criteria first.

Is the customer waiting for approval of a PES or ABSTUDY PES qualifying pension or payment?

• Yes, go to Step 6
• No, go to Step 7

Has the customer submitted a claim for a qualifying pension or payment?

• Yes, and they do meet all other requirements for PES, change the claim Status:
• On hold reason - Waiting on ISP
• Due date - 21 days from claim lodgement
  If the claim is re-allocated after day 21 or a further hold period, and the qualifying payment has not yet been processed, update the Due date for a further 14 days pending the outcome of the customers claim for ISP
• Yes, and they do not meet all other requirements for PES, reject the claim. See Table 3
• No, reject the claim. See Table 3

Customers with a Social Security Act qualifying payment only need to provide identity documentation if they did not meet Identity Confirmation requirements when claiming their qualifying payment. For DVA customers, identification documentation is required if their identity is not confirmed with Services Australia.

Does the customer meet all the PES qualifications or, will they meet within 13 weeks of the date of lodgement?

• Yes, go to Step 9
• No, reject the claim, see Table 3

An earlier grant date may apply to ABSTUDY PES. To confirm the correct date of grant, the claim must be assessed by an ABSTUDY Processing Service Officer.

Use Fast Note - select Auto text, Students, ABSTUDY & Apprentices > Enquiry > ABSTUDY PES suitability enquiry

Change the claim status to:

• On Hold Reason: Waiting on ISP
• Due date: 21 days from today's date

Procedure ends here.

To qualify for PES, the customer must be:

• undertaking or intending to undertake an approved course of study at an approved institution, see Assessing qualifying study for Pensioner Education Supplement (PES) and
• have not completed a Masters or Doctorate degree or qualification. PES claimants who have previously completed a Master or Doctorate degree do not qualify for assistance irrespective of the course they are currently studying

Other resources that may assist in assessing a PES claim include:

• Eligibility periods for full year courses of study for ABSTUDY, ABSTUDY Pensioner Education Supplement (PES) and PES
• Assessing satisfactory progress and allowable time for tertiary students for Pensioner Education Supplement (PES)
• Late commencement of course for ABSTUDY, ABSTUDY Pensioner Education Supplement (PES), Austudy, PES, and Youth Allowance (YA)
• Assessing the disability study load concession for ABSTUDY and ABSTUDY Pensioner Education Supplement (PES)
• Assessing eligibility for 25% concessional study load for Pensioner Education Supplement (PES)

Is the student undertaking or intending to undertake qualifying study for PES?

• Yes, the customer qualifies for PES:
• If the customer is in receipt of a Department of Veterans Affairs payment, go to Step 10
• If the customer recently transferred to a qualifying payment for PES and claimed PES prior to the transfer date, go to Step 11
• If the customer's previous PES payment was cancelled within 13 weeks and can be restored, go to Step 12
• for all other customers, see Table 2
• No, as the customer does not qualify for PES reject the claim, see Table 3

PES claims submitted online will have a priority keyword SUPDVA if they are a DVA recipient. These claims have a higher priority in WLM for allocation, to allow for the lead time to obtain DVA clearance.

Check for Identity Confirmation. PES customers receiving a qualifying DVA payment will be required to provide confirmation of identity. In most cases, their identity has not been confirmed to Services Australia. Ensure appropriate identity has been requested in the new claim, if it has not issue a request using the Request for Information (RFI) workflow.

The DVA Clearance Team can confirm if the customer is receiving a qualifying payment from DVA.

• Use Fast Note - select Auto text, use Generic > Enquiry > DVA Clearance/Advice Request

Ensure all relevant information is recorded.

Change the claim Status to:

• On Hold Reason Waiting on ISP
• Due date - 21 days from claim lodgement

Normal processing rules around holding claims and duration of the hold apply.

The DVA Clearance Team will update information on the DVA Payments screen (DVA/DVAS) to confirm eligibility.

Once clearance is received check, if the customer is receiving a qualifying payment from DVA,

• Yes, see Table 2
• No, reject the claim, see Table 3

PES claims may incorrectly reject Qualifying payment not current (CQP) where the:

• PES claim has a Date of Receipt prior to the customer benefit transferring to another Income Support Payment (ISP), and
• PES claim is being processed after the benefit transfer has been finalised

If the customer meets all other PES qualifications:

• Take note of the date of the ISP benefit transfer date (for example. the date the new ISP was granted from)
• Navigate to the Status screen in Process Direct and change the claim status to Not Required
• Go to the Process Direct Landing page:
• Select SOA Shell tile to go to the SOA Shell Creation screen
• Select Benefit Type: Pensioner Education Supplement
• Enter Customer CRN
• Enter the Date of Receipt as the date customer was granted new ISP
• Select Create Claim
• Process the PES claim using the manually created SOA Shell

Ensure the claim finalisation Note has details of workaround used, see Table 2.

If the claim is not required to be assessed, manually change the status of the claim to Not Required.

Examples of appropriate use include, but not limited to:

• If a SOA Shell claim has been created, but after investigation:
• is not needed because another action can be taken on the record (such as restoration), or
• there is an existing claim available (where the Date of Receipt is within 12 months of the system date)
• A claim does not require assessment. For example, a previous claim has been rejected. The customer lodges a subsequent claim and it is determined that:
• a reassessment of the previous claim is deemed appropriate, or
• a previously cancelled payment can be restored

Note: changing the claim to Not Required is final and the status cannot be changed again.

Before changing the status to Not Required, consider all other actions on the record to reduce the risk of changing the status incorrectly.

In Process Direct:

• Open the claim
• Go to Status
• Select:
• Edit and change the status from In Process to Not Required
• Save
• Record the reason in the Notes section

Where a claim has had a Not Required status incorrectly applied, another claim will need to be manually created, using the SOA Shell application in Process Direct.

Procedure ends here.

Check if the claim is a paper claim by opening the claim slider. For paper claims, use information from the scanned SY004 form (Documents screen) to process the claim in the relevant screens.

Determine if an allowable time assessment is required see Assessing satisfactory progress and allowable time for tertiary students for Pensioner Education Supplement (PES):

Is an allowable time end date coded?

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

When an ATED is coded for a PES new claim, the system:

• does not issue a Grant or Reject advice letter automatically
• creates an Advice (ADV) activity the next day for a manual follow up

To make sure customers get the correct advice the ATED must be coded based on if it is after, or before the date the claim is assessed.

If the allowable time end date is:

• on, or earlier than the date of processing:
• reject the claim, see Table 3
• grant the claim for a period and then cancel payment due to Allowable time Reached
  code the ATED within the claim activity and finalise the claim. This will allow the system to both grant and cancel within the same activity, once the claim is finalised, inhibit the automatic grant letter during claim finalisation, go to Step 3
• later than the date of processing, process and finalise the claim without coding the future ATED, go to Step 3

Review the information in the PES claim to code the claim.

Note: students undertaking a Startup Year Course to be eligible for a student payment, must:

• provide evidence they are enrolled in the course, and
• have been selected for a STARTUP-HELP loan by their higher education provider

For information on coding the Customer Study Details (EDCH) screen see Coding new study details:

• On the EDC screen code all study details as required
• Update Enrolment Verification as either VER (Verified) or VRR (Verification Required) on EDC screen see Proof of enrolment (POE) in a course of study, for instructions
• Update the Education Payments Start Date (EPDC) screen if required. If no EPDC screen details exist:
• select Add
• when the Create Education Payment Details screen appears, ensure all fields are blank and select Save
• the system will automatically populate the correct dates
• provisional data will display on the EPDC screen
• check Office Code OC screen and update, if required
• select any other relevant screens for updating as required

If the customer is:

• in receipt of a Department of Veterans' Affairs (DVA) payment, go to Step 4
• for all other customers, see Table 3

Note: in limited circumstances information automatically populated on the EPDC screen may not be correct. If a manual start date is to be coded, ensure the RSN manual start date field is coded as MWA - manual workaround.

Additional coding is required on the EPDC screen for customers in receipt of a qualifying DVA payment.

Code the DVA Payment Type based on the DVA payment the customer is receiving. For:

• Disability Compensation Payment, Veteran Payment, Permanent Impairment and Special Rate Disability Pension - use code ISP (Invalidity Service Pension)
• Wholly Dependent Partner - use code DWP (Defence Widow's Pension)

Grant claim, go to Step 4

Reject claim, because of one of the following reasons:

• APP - Full-time apprentice or trainee
• CQP - Qualifying payment not current
• MDC - Completed Masters or Doctorate
• NAC - Enrolled in unapproved course
• SUH - Not entitled to STARTUP-HELP
• NAI - Not an approved institution
• NAS - Not a student Note: Do not use the rejection code NAS for PES customers studying under 25% of a full-time study load. Once EDC is coded with the correct Participation Status, the claim will automatically reject with code U25.
• FSD -Failed to supply documents Note: PES claims should not be rejected FSD for POE unless it is required to determine qualification or rate. See Proof of enrolment (POE) in a course of study.
  If the customer has not supplied POE verification, the Customer Study Details (EDCH) screen should be coded 'VRR', this causes the record to automatically suspend if POE is not coded after 28 days from the study start date, or the date the new claim is finalised
• Go to Step 2

For all other rejection reasons including, allowable time end date being on or earlier than the date of processing, go to Step 3

If the PES claim is to be streamline rejected, the claim does not need to be coded before completing the rejection.

Note: make 1 genuine attempt to contact the customer by phone before finalising the decision.

Streamline reject the claim:

• From the TS screen, select Process
• Delete any provisional coding on the Customer Study Details (EDCH) screen
• Go to the Benefit Action (BA) screen
• Select Add to create a new entry and update:
• Benefit Type Code field, select the correct benefit type
• Benefit Action field, REJ - reject
• select the Streamline Rejection Indicator
• Reason field, select the appropriate reason
• Date of Effect field, defaults to the claim submission date
• select Save. A new provisional line displays on the BA screen
• Go to the SWE screen:
• Message Log displays any errors with existing coding. Errors must be fixed before assessing the claim. For help, see Using Digital Assistant Roxy in Process Direct
• Select Assess to go to the Entitlement ELD screen
• Check the outcome is correct on the ELD screen, and select Finish
• Record the details in the finalisation Note
  If the rejection reason is Failed to Supply Documents (FSD), list all outstanding mandatory documents in the finalisation Note
• Select Finalise

Go to Step 5.

Check cancellation, suspension and rejection reason codes. Only use rejection code 'Other' (OTH) if no other rejection code is appropriate.

Note: make 1 genuine attempt to contact the customer by phone before finalising the decision.

If rejecting the claim due to 'Allowable Time Reached' or 'Start Date is >13 weeks in the future' use rejection reason 'OTH'. A manual rejection letter must be issued after finalising the claim.

• Go to the BA screen
• Select Add to create a new entry and update:
• Benefit Type Code field: select the appropriate benefit type
• Benefit Action field: REJ-rejection
• Rejection Reason Code: select the rejection reason code, Do not select the Streamline Rejection indicator
• Reason field: select the appropriate reason
• Date of Effect field: defaults to the claim submission date
• Select Save. A new provisional line displays on the BA screen
• Go to the SWE screen
• Message Log displays any errors with existing coding. Errors must be fixed before assessing the claim. For help, see Using Digital Assistant Roxy in Process Direct
• Select Assess to go to the ELD screen
• Check the outcome is correct on the ELD screen, then select Finish
• Record details in the finalisation Note
• Note: if the rejection reason is Failed to Supply Documents (FSD), list all outstanding mandatory documents in the finalisation Note
• Select 'Finalise'
• If the claim has not auto-generated a Note (that is, an abridged claim or where the claim is both granted and cancelled in the same activity), create a Note. See Online Document Recording (ODR)

After the rejection activity is finalised go to the AL screen. Has a Manual Follow-up (MFU) activity been created?

• Yes, generate create a manual letter (Q134) in Customer First and include:
• the reason(s) for rejecting the claim
• of the applicant's right of review and appeal
• see the Resources page for approved letter text for allowable time and early claim rejections, go to Step 5
• No, for:
• Service Officers, if the customer is in receipt of Carer Payment go to Step 7, otherwise procedure ends here
• QMA officers go to Step 8

Select Assess.

On the Entitlements (ELD) screen, check the outcome. Is the outcome correct?

• Yes, select Finish, go to Step 6
• No, and:
• Error: X511AS - PE date does not align with customer EPEDC Cluster/PES Cur Navkey: #PLENT occurs, go to Step 5
• for all other errors, correct any screens required. Select Finish, go to Step 6

When this error occurs wait until after the first entitlement period of the new payment has passed before processing the claim as the bug no longer occurs after the end of the first entitlement period.

For example, if granting from 14 April 2009, the first entitlement period is 14 April 2009 to 27 April 2009. On 28 April 2009 (or later), the bug will not occur and the claim can be finalised.

Note: the customer will receive their first payment one day late if the claim is finalised on the first day after the end of the entitlement period.

The Claim Finalisation Note displays. Edit or add any extra details required.

Select Finalise to complete the claim. A confirmation dialog box appears. Select OK.

Where a checklist of scans displays, mark each as complete using the tick boxes to close them.

Has an Education Entry Payment (EdEP) been granted during the PES claim process?

• Yes, go to Step 7
• No, check if the customer meets eligibility requirements to receive EdEP, for coding instructions, see Education Entry Payment (EdEP). If the customer is eligible for EdEP, grant the payment, go to Step 7

If the claim has not auto-generated a Note create a Note including relevant Guide and Act references and all additional information. See Online Document Recording (ODR).

Has an Allowable Time End Date (ATED) been coded within the claim, or does an ATED need to be coded now the claim has been finalised?

• Yes, go to Step 8
• No, for:
• Service Officers, if the customer is in receipt of Carer Payment go to Step 9, otherwise procedure ends here
• QMA officers go to Step 10

If a claim has been granted for a period and then cancelled due to Allowable Time Reached:

• Send an email to the YEE.SUPPORT team to have a grant/cancellation letter issued

If an ATED needs to be coded on the Customer Study Details (EDCH) screen that is later than the date of processing:

• Create an open Fast Note - select Auto text, use Students, ABSTUDY & Apprentices > Pensioner Education Supplement > PES Allowable Time End Date
• Select the held option within the Fast Note template
• Code the resubmit date as the next business day
• Once the template content is complete, select Continue
• Do not close the open DOC created by the workflow
• If the claim is selected for Quality Management Application (QMA), document that the ATED will be coded after the claim is finalised
• Issue a Q888 to the customer, see Creating a Q999 or Q888 letter. Include the following approved wording in the free text paragraph:
  'Following an assessment of your allowable time based on previous studies undertaken at the same level as the course you are doing now, it has been determined we can pay you Pensioner Education Supplement until XXXX. Your Pensioner Education Supplement will cancel on XXXX because you will have reached the maximum time allowed for your course.'

Is the customer in receipt of Carer Payment?

• Yes, go to Step 9
• No:
• Service Officers, go to Step 10
• QMA officers, go to Step 11

Carer Payment customers hours of study may impact their ongoing entitlement to CP, see Carer Payment (CP) and Carer Allowance (CA) carer undertakes paid employment, self-employment, voluntary work, education or training activities.

After the PES claim has been finalised for a CP customer create a Fast Note to notify Carer Payment trained Service Officers that a customer has started studying:

• Use Fast Note - select Auto text, use Carers > Update > Commenced Study - CPAS to be updated
• complete the template content
• select Continue
• do not close the DOC created by the workflow
• For:
• Service Officers, go to Step 10
• QMA officers, go to Step 11

The customer may be eligible to receive Education Entry Payment.

Check if the customer meets eligibility requirements to receive EdEP, see Education Entry Payment (EdEP).

Is the customer eligible to receive EdEP?

• Yes, grant the payment. For coding instructions, see Education Entry Payment (EdEP)
• No, include the decision regarding EdEP by annotating the existing reject DOC. Procedure ends here

Complete QMA checks as per existing processes.

Check if there is an existing Commenced Study - CPAS to be updated open Fast Note on the record for Carer Payment customers.

Check if there is an existing PES Allowable Time End Date open Fast Note on the customer's record.

If there is an open Fast Note more action is needed from the QMA.

If there is no open Fast Note Quality Management Officers must create one, using the Auto Text function:

• For Carer Payment Fast Note instructions refer to Carer Payment
• For Allowable time End Date (ATED) Fast Note refer to ATED follow up actions

Do not close the open DOC created by the workflow.

Give feedback to Service Officers if they did not follow this process.

Note: the process above applies to both granted and rejected claims.