Medicare Compensation Recovery 011-15000000

System letter code

Recipient

System letter name and brief description

Z2797

Any (informant)

(Two options, 3 different headings)

You do not need to tell us about the compensation claim/reimbursement arrangement

Tells recipients that:

• the compensation claim is not notifiable under the HOSC Act, or
• the injured person has told us that there was not a notifiable claim under the HOSC Act

Or

Compensation claim cannot be registered

Tells them that no Medicare record was found for injured person details as provided.

Z2798

Any (informant)

We need more information to register a compensation claim

Tells recipients that the submitted form was missing information and asks them to submit a new completed form and/or supporting documents.

Z2799

Injured person or Claimant

(Two options, same heading)

Information about a compensation claim

Tells recipients that:

• a compensation claim has been registered and that they need to visit our website to find out their responsibilities, or
• injury date and/or description has been updated on an existing claim and shows previously advised and new details

Z2800

Injured person or Claimant

Identify related Medicare history and/ care services

Asks recipients to complete the attached Medicare history statement (if relevant), care services statement and declaration.

Z2801

Injured person or Claimant

Medicare history and/ care services statements

Asks recipients to tick yes or no for each listed service (Medicare or care) and to sign the declaration.

Z2802

Any (sender)

We are unable to process the notice of past benefits request/third party authority/ notice of judgment or settlement/reimbursement arrangement

Tells recipients that we cannot process the form because it is missing information or supporting documents. Asks them to submit a new completed form and/or supporting documents.

Z2803

Injured person or Claimant (case processing)

or

Any (resend)

Compensation claim document enclosed

When issued via case processing, tells recipients that the enclosed document was sent to the compensation payer or insurer and is only sent for their information.

Sent with copy of Z2807, Z2808, Z2809, Z2810, Z2811 or Z2812.

When issued via resend action, tells recipients that the enclosed document was sent as requested.

Z2804

Injured person or Claimant

(Five options, 5 headings)

Extension of period to give a statement – request granted/refused

Tells recipients that an extension has been granted (approved) or refused (rejected).

Or

Reconsideration of decision to extend a period to give a statement - decision affirmed/ substituted/varied

Tells claimant or authorised third party that the decision to grant or refuse has been reviewed and affirmed (decision stays the same), substituted (opposite decision) or varied (same decision with altered conditions).

Z2805

Injured person or Claimant

(Two options, 2 headings)

First/Second notice – statement not substantially correct

Asks recipients:

• for a letter from a treating doctor letter to remove previously verified services that have now been changed to no, and/or
• to complete new Medicare history statement and/ care statement and declaration

Z2806

Injured person or Claimant

(Three options, 3 headings)

Notice of refusal

Tells recipients that their request for us to issue a new notice of past benefits/charge was refused.

Or

Reconsideration of decision to refuse to issue a notice - affirmed/varied

Tells recipients that the decision to refuse has been reviewed and affirmed (stays the same) or varied (changed).

Z2807

Notifiable person

A copy is sent to the Injured person or Claimant with Z2803

(Two options, 2 headings)

Notice of past benefits or charge

Tells recipients the amount to be recovered after compensation amount is fixed within the next 6 months. Amount based on ticked services on a returned statement by claimant. Sent pre-settlement.

Or

Notice of past benefits or charge – all services taken

Tells recipients the amount to be recovered after compensation amount is fixed within the next 6 months. Amount includes all services as a statement by claimant was not returned. Sent pre-settlement.

Z2808

Notifiable person

A copy is sent to the Injured person or Claimant with Z2803

Compensation related Medicare benefits and/or care services

An itemised list of all services the claimant has identified are related to the compensable injury/illness. This list is not sent if statement by claimant was not returned. Sent pre or post settlement with the Z2807 or Z2811.

Z2809

Notifiable person

A copy is sent to the Injured person or Claimant with Z2803

Compensation payer has not complied with legislated notice requirements

Tells recipients that they are liable to pay any outstanding charge, and not to pay any of the compensation amount until the charge has been paid. Sent post-settlement.

Z2810

Notifiable person

A copy is sent to the Injured person or Claimant with Z2803

Advance payment criteria not satisfied

Tells recipients that they have not discharged their liability. They may not pay any part of the compensation amount to the claimant until the charge has been paid.

Z2811

NOC:

Notifiable person

A copy is sent to the Injured person or Claimant with Z2803

NOPB-AP:

Injured person or Claimant

(Four options, 4 headings)

Notice of charge

Tells recipients the amount to be recovered, there is no amount to pay, or a refund is due. Amount based on ticked services on a returned statement by claimant. Sent post-settlement.

Or

Notice of charge – all services included

Tells recipients the amount to be recovered, there is no amount to pay, or a refund is due. Amount includes all services as a statement by claimant was not returned. Sent post-settlement.

Or

Notice of past benefits – advance payment

Tells recipients an advance payment was made and there is

• no amount to pay
• a refund due, or
• a remaining amount to pay as it was not enough

Amount based on ticked services on a returned statement by claimant. Sent post-settlement.

Or

Notice of past benefits – advance payment – all services included

Tells recipients an advance payment was made and there is no amount to pay, a refund due, or a remaining amount to pay as it was not enough. Amount includes all services as a statement by claimant was not returned. Sent post-settlement.

Z2812

Notifiable person (in response to S24(4) or S25(4))

A copy is sent to the Injured person or Claimant with Z2803

Injured person or Claimant (in response to S33K)

Past benefits and subsidies will not be recovered

Tells recipients that:

• more than 3 months have passed since NOJS or Advance Payment was received (whichever is later)
• any payments will be returned, and
• no amount will be recovered

This letter is issued in relation to HOSC Act sections 24(4), 25(4) or 33D/33K.

Z2813

Any (stale cheque recipient)

Medicare Compensation Recovery funds

Tells recipients:

• cheque has gone stale, or
• compensation payer wants to redirect NOC refund to the injured person
• requests a completed bank account details form so we can deposit money via EFT

Manual letter code

Recipient

Manual letter name and brief description

Z2277

Any (payer)

We need more information to process a payment

Tells recipients that money has been received but there was no remittance advice to tell us who/what it was for.

Z2451

Any (requester)

Compensation claim document enclosed

Go to Table 1 above for detail on when to use this letter.

This is the manual version of the Z2803.

Form

Who can sign

What the agency requires

Third party authority (MO021)

For injured person or claimant to authorise a person or entity to receive information about their compensation claim and sign documents on their behalf.

• Injured person 14 years or over
• Parent of a minor, or
• Legal representative (i.e. guardian, executor, public trustee, power of attorney or financial manager)

The authorised third party must co-sign the document.

If not the injured person:

• Medicare card to show parent or guardian relationship, or
• Legal document to show parent relationship or court appointed power/authority if relevant

Notice of judgment or settlement (MO022)

For notifiable person (compensation payer or insurer) to advise the agency that a compensation amount has been fixed by judgment or settlement.

• Notifiable person
• Notifiable person’s solicitor
• Compensation payer
• Insurer

Copy of the judgment or settlement documents.

Section 23A statement (MO023)

For injured person or claimant to declare that:

• since the last NOPB they have not received any further related benefits

Or

• they have never received any related benefits (if a NOPB has never been issued)

Not the authorised third party or solicitor.

If not the injured person:

• Medicare card to show parent or guardian relationship, or
• Legal document to show parent relationship or court appointed power/authority if relevant

Bank account details collection (MO024)

For injured person or claimant to provide bank account details if entitled to a refund.

• Injured person 14 years or over
• Parent of a minor, or
• Legal representative (i.e. guardian, executor, public trustee, power of attorney or financial manager)

Not the authorised third party or solicitor.

If not the injured person:

• Medicare card to show parent or guardian relationship, or
• Legal document to show parent relationship or court appointed power/authority if relevant

Compensation payer’s Electronic Funds Transfer details collection (MO025)

For compensation payer to provide bank account details if entitled to a refund.

Compensation payer only

Nil

Notice of past benefits request (MO026)

For any party to a claim to request that a statement be issued to the injured person or claimant for them to identify related services, and a notice of past benefits or charge can be issued to the notifiable person.

• Injured person 14 years or over
• Parent of a minor
• Legal representative (i.e. guardian, executor, public trustee, power of attorney or financial manager)
• Authorised third party
• Notifiable person
• Notifiable person’s solicitor
• Compensation payer
• Insurer

If not the injured persons:

• Medicare card to show parent or guardian relationship, or
• Legal document to show parent relationship or court appointed power/authority if relevant

Notice of reimbursement arrangement (MO027)

For notifiable person to advise the agency that a reimbursement arrangement was made (accepting liability to pay medical expenses as they are incurred) more than 6 months after a compensation claim was made.

• Notifiable person
• Notifiable person’s solicitor
• Compensation payer
• Insurer

Copy of appeal decision if relevant

Commonwealth of Australia Declaration Criminal Code Act 1995 (MO028) – link not available to external audiences Only to be used for certain legacy CCMS cases.

For injured person or claimant to declare if related care services were received and that identified items ticked on the accompanying Medicare history statement are true and correct.

• Injured person 14 years or over
• Parent of a minor
• Legal representative (i.e. guardian, executor, public trustee, power of attorney or financial manager)
• Authorised third party

If not the injured person:

• Medicare card to show parent or guardian relationship, or
• Legal document to show parent relationship or court appointed power/authority if relevant

Letter

Terms

A-H

Go to: I-R, S-Z

ad-hoc payment, advance payment (AP), Aged Care Management Payment System (ACMPS), Aged Care Staff Portal, all services included, authorised third party (ATP), care costs, care services statement, case, case notes, claim, claimant, Client and Service Provider eAnalysis Reporting (CASPER), closed (claim), compensable person, compensation agent, Compensation Case Management System (CCMS), compensation payer, consent judgment, Consumer Directory Maintenance System (CDMS), date of birth (DOB), declaration, Government regulatory authority

Term

Description

Advance Payment (AP)

Equal to 10 percent of the compensation amount fixed under judgment or settlement, where there is no valid Notice of past benefits at date of judgment or settlement.

Is received by Services Australia within 28 days from date of judgment or settlement, and both the agency and the injured person (or claimant) have received written notifications that the insurer intends to make that advance payment within legislative timeframes.

Go to Payments, refunds and debts.

ad-hoc payment

Any payment received which does not match a notice of charge amount, and where the advance payment criteria is not met.

Was previously known as a voluntary recovery or voluntary payment. Listed as ‘other claim related payments’ on a notice of past benefits or notice of charge.

Go to Payments, refunds and debts.

Aged Care Management Payment System (ACMPS)

ACMPS is a SAP database accessed via ESSentials used by Medicare Compensation Recovery to confirm if any care subsidies have been paid on behalf of a specific person. For nursing home or residential care go to care costs.

Aged Care Staff Portal (ACSP)

An online resource owned and maintained by Department of Health and Aged Care, used by Medicare Compensation Recovery to confirm if any care subsidies have been paid on behalf of a specific person. For nursing home or residential care go to care costs.

all services included

All services that were listed on the notice to claimant are considered to be related to the claim because the claimant did not return a statement by the due date.

May apply to a notice of past benefits – all services included or a notice of charge – all services included.

Go to Notice of past benefits (NOPB) and Notice of charge (NOC).

authorised third party

(ATP)

Either an organisation (such as an injured person’s solicitor) or an individual (such as a friend or relative) who is authorised by the injured person (or claimant) to act on their behalf on a Third Party Authority form (MO021). Go to third party.

May be known as the:

• authorised person
• injured person’s/claimant’s authorised solicitor

Note: an authorised third party may sign documents on behalf of the injured person or claimant as per the authority given to them on the MO021 form.

An insurer's solicitor or compensation administrator is considered a delegate and/or agent and may act on behalf of the notifiable person/compensation payer.

Go to Enquiries and authenticating a customer and Authority to access a claim.

care costs

Nursing home benefits, residential care subsidies and home care subsidies recoverable under Division 2 of the Health and Other Services (Compensation) Act 1995. Previously referred to as a 'nursing home check'.

Go to Statement by claimant (SBC) and care costs - Medicare Compensation Recovery.

care services statement

Advises if an injured person was admitted to care or received an increase in level of care due to the compensable injury or illness. Covers the period from the date of injury to the date the statement was issued or the date of judgment or settlement, whichever is earlier. This question previously formed part of the MO028 form.

This forms part of the statement by claimant together with a completed Medicare history statement and declaration.

Go to Statement by claimant (SBC) and care costs - Medicare Compensation Recovery.

case

A term used in MCRS to describe a work item or task within a compensation claim that requires processing.

case notes

A public record of information created, sent and received in the course of carrying out business on behalf of the agency.

Case notes can be requested under Freedom of Information Act 1982 provisions.

Where possible, staff should use the case notes template to ensure all important information about a process has been included.

claim

A claim for compensation.

claimant

The person seeking compensation either

• on their own behalf or
• on behalf of another person

The claimant is either the injured person or

• a parent/guardian (if injured person under 14 years - minor, or over 14 years and they have been medically diagnosed as mentally or physically incapable of managing their own affairs)
• a legal representative e.g. executor, public trustee, power of attorney or financial manager

Go to compensable person.

closed (claim)

A claim is automatically closed by MCRS when all processing on a claim has been finalised and a charge has been issued.

A claim may be manually closed (terminated) by a Service Officer in MCRS before all processing has been completed. Go to Close, terminate, update or reopen a claim.

Client and Service Provider eAnalysis Reporting (CASPER)

An online resource owned and maintained by Department of Health and Aged Care used by Medicare Compensation Recovery to confirm if any home care subsidies have been paid on behalf of a specific person.

For nursing home or residential care go to care costs.

compensable person

An individual who is entitled to receive compensation for an injury or illness. If the individual has died, this can be the individual’s estate.

Use 'injured person' wherever possible to be specific.

compensation agent

Manages claims on behalf of insurers, brokers, government bodies and self-insured organisations.

Also includes compensation delegate and compensation administrator. They may act for the compensation payer, notifiable person or insurer and do not require a Third Party Authority.

compensation payer

The person who is liable to make a payment of compensation. Can be a notifiable person or insurer.

Compensation Case Management System (CCMS)

CCMS was decommissioned in 2023. CCMS was a suite of Staffware^TM workflow applications that was used to manage the business processes of Medicare Compensation Recovery.

Go to Medicare Compensation Recovery System (MCRS). Legacy CCMS claim data can be imported to MCRS if needed.

consent judgment

A consent judgment may be made when parties come to an agreement about a settlement and ask the court to make orders based on that agreement.

It is different to a decision by a court. Go to Notice of judgment or settlement (NOJS).

Consumer Directory Maintenance System (CDMS)

A database used by the agency to manage Medicare enrolment data, including demographic information such as names, date of birth, gender and addresses. Go to Search for or update an existing claim or register a new claim.

Go to Consumer Directory Maintenance System (CDMS) for Medicare.

date of birth (DOB)

The date of birth of the injured person as recorded by an official institution, for example in Australia the state or territory registry of Births, Deaths and Marriages.

declaration

A written statement in which the signatory declares that the contents are true.

For Medicare Compensation Recovery purposes, the signatory acknowledges that they understand that giving false or misleading information is a serious offence under the Criminal Code Act 1995 (punishable by imprisonment for 12 months).

Note: only a statutory declaration needs to be signed and declared in the presence of an authorised witness.

Government regulatory authority

An autonomous authority or agency established by a federal, state or provincial government with the power to enforce regulations regarding occupational health and safety.

For example, SafeWork NSW, WorkSafe VIC, WorkCover QLD etc.

Letter

Terms

I-R

Go to: A-H, S-Z

injured person, injury, insurer, judgment, legal representative, Medicare Compensation Recovery System (MCRS), Medicare history statement, Notice of charge (NOC), Notice of past benefits (NOPB), Notice to claimant, notifiable compensation claim, notifiable person, parent, reimbursement arrangement

Term

Description

injured person

The individual who has suffered an injury or illness. Also known as the 'compensable person'.

The injured person is the claimant unless the claim is being made on their behalf.

injury

Harm, damage or impairment to the injured person. May be physical or psychological and includes an illness or disease relating to the compensation claim.

insurer

Referred to in the Health and Other Services (Compensation) Act 1995 as the 'compensation payer' or the notifiable person. Note: this may not actually be an 'insurer' in the strict sense in all instances.

judgment

An order by a court or compensation authority that fixes a compensation amount. It does not include a reimbursement arrangement or a consent judgment (or an order in the nature of a consent judgment).

legal representative

A person or entity who has been appointed by law to act on the injured person’s behalf such as:

• guardian
• estate executor (if the injured person has died)
• administrator (letters of administration)
• public trustee
• power of attorney
• financial manager

Note: this is not the claimant’s solicitor or lawyer.

Medicare Compensation Recovery System (MCRS)

The claim processing system used in Medicare Compensation Recovery to calculate recoverable amounts, and to issue letters and notices.

Medicare history statement

An itemised list of professional services received by an individual for which Medicare benefit was paid. Covers the period from the date of injury to the date the statement was issued or the date of judgment or settlement, whichever is earlier.

Previously known as a 'Claims History Statement'. This is different to a Medicare claims history available via myGov, because it only lists services between the date of injury and the date of statement issue and is only for Medicare Compensation Recovery purposes.

This forms part of the statement by claimant together with a completed care services statement and declaration.

Go to:

• Statement by claimant (SBC) and care costs - Medicare Compensation Recovery
• Notice of past benefit request and notice to claimant

Notice of charge (NOC)

A final notice that does not expire. Provides the total amount of recoverable Medicare benefits and care costs (nursing home benefits, residential care subsidies and home care subsidies) which the agency believes were paid in respect of treatment for, or as a result of, a compensable injury.

A notice of charge considers any payments already received for that claim and is based on the statement by claimant (or notice to claimant if the statement was not returned).

A notice of charge is payable within 28 days of issue because the compensation amount has been fixed.

Go to Notice of past benefit request and notice to claimant.

Notice of past benefits (NOPB)

An interim notice valid for 6 months. Provides the total amount of recoverable Medicare benefits and care costs (nursing home benefits, residential care subsidies and home care subsidies) which the agency believes were paid in respect of treatment for, or as a result of, a compensable injury.

A notice of past benefits considers any payments already received for that claim and is based on the statement by claimant (or notice to claimant if the statement was not returned).

A notice of past benefits is only payable if a claim settles while it is still valid - it then becomes the notice of charge for that claim.

Go to Notice of past benefit request and notice to claimant.

Notice to claimant (NTC)

Referred to in section 17 of the Health and Other Services (Compensation) Act 1995.

Sent to the claimant to advise of their requirement to repay Medicare benefits and care costs related to their compensation claim. It contains a Medicare history statement to identify services related to the injury/illness and a declaration for the claimant or authorised third party to complete regarding related care costs.

Go to Notice of past benefit request and notice to claimant.

notifiable compensation claim

• A claim for a compensation amount of more than $5,000 (including legal costs for settlements), or
• A reimbursement arrangement made more than 6 months after the claim for compensation was made

Go to Notifiable and not notifiable claims.

notifiable person

Usually an insurance company, but in relation to a compensation claim may be:

• the insurer, if the person against whom the claim was made was/is insured for liable claims
• a representative organisation, if the person against whom the compensation claim was made was/is a member and covered for liable claims, or
• the person against whom the claim was made

Referred to as the compensation payer after judgment or settlement.

parent

Care giver/Father/Mother of a child.

Relationship can be confirmed by Medicare card that includes the child or copy of legal documentation verifying the relationship and the authority to act on behalf of the child. An MO021 must be completed by an injured person 14 years or over that is mentally capable of handling their own affairs.

reimbursement arrangement

An agreement in writing, an order of a court, or a decision of a person or body, that the person against whom the claim is made is liable to pay compensation to reimburse the claimant for expenses as they are incurred and

• are incurred in respect of services or care provided to treat or as a result of the injury or illness
• are expenses for which an eligible benefit is or may become payable

Payment under a reimbursement arrangement is made by the notifiable person.

Letter

Terms

S-Z

Go to: A-H, I-R

Section 23A statement, settlement, solicitor – injured person's, solicitor – insurer's, Statement by claimant, System for the Payment of Aged Residential Care (SPARC), third party, work item number (WIN)

Term

Description

Section 23A statement

A declaration by an injured person or claimant that declares:

• no eligible benefits have been received in relation to the injury of illness, or
• no further eligible benefits have been received in relation to the injury of illness since the expired notice of past benefits

settlement

An agreement that fixes a compensation amounts that parties to the agreement will pay. It does not include a reimbursement arrangement. It includes:

• an agreement for redemption of a fixed amount entitlement to compensation by periodic payments
• a consent judgment, or an order in the nature of a consent judgment by a court or compensation authority

solicitor – injured person's

Nominated by the injured person or claimant to send us correspondence relating to their compensation claim. Must be authorised on an MO021 by a claimant to act on their behalf.

Has studied law, completed practical legal training, and been admitted to the Supreme Court of their state or territory. They must have a current practising certificate and be insured.

solicitor – insurer's

Nominated by the insurer to represent them for the claim. An MO021 form is not required.

Go to compensation agent.

Statement by claimant

Referred to in section 18 of the Health and Other Services (Compensation) Act 1995. This is the returned Medicare history statement, care services statement and declaration signed by the injured person, claimant or authorised third party. It verifies the Medicare services they believe relate to their compensation claim, and whether they have received related care in a nursing home, residential care facility, or home care services.

Go to Statement by claimant (SBC) and care costs - Medicare Compensation Recovery.

System for the Payment of Aged Residential Care (SPARC)

SPARC was decommissioned on 20 August 2022. SPARC was a Medicare mainframe database used by Medicare Compensation Recovery to confirm if any nursing home benefits or residential care subsidies have been paid on behalf of a specific person. Service Officers must use the Aged Care Staff Portal (ACSP) to obtain residential care information from 20 August 2022. For home care subsidies Go to ACMPS.

third party

A person or group with an interest in the claim, other than the injured person (or the claimant) and Services Australia. May also be known as 'injured person/claimant's solicitor', compensation payer, notifiable person or insurer. Go to also authorised third party.

Note: a claimant’s solicitor must be authorised (MO021) by the claimant before they can access information about the claim on behalf of their client.

work item number (WIN)

An individual claim identifier allocated by MCRS at claim registration.

Provisional WINs are created when sufficient information is not received to fully register.

Type of injury or illness

Notifiable date of injury or illness

General injuries or illnesses

Date the injury or illness was sustained or occurred

Diseases for example, industrial deafness/hearing loss

Date the disease was first diagnosed

Medical Negligence

Date of the failed procedure or misdiagnosis

Mesothelioma or Pleural diseases

Date of diagnosis

Alveolitis, Asbestosis, Pneumoconiosis, Pulmonary Fibrosis, Siderosis, Silicosis

First day a service was definably directed to the treatment or alleviation of symptoms associated with the disease

Historical abuse claims with only:

• date range
• month and year, or
• year

If exact date is unknown, write the 1st of the month and year or date of the first treatment.