Document Assessment - Medicare Compensation Recovery 011-15010000

REFLECT model

Table 1: This table provides guidance on how to apply the REFLECT model, including the questions service officers should consider and the actions they should take at each step.

Reflect steps	Ask yourself	What to do
RE - Recognise the issue	What is the problem and what decision needs to be made? What happened?	Recognise the situation which requires a decision or action. Distinguish genuine issues from routine variations. Identify the circumstances - What needs to be decided and whether there is an ethical, legal, policy or evidence issue.
F - Find information	What is needed to make a decision? Who is affected? What information is missing or needed?	Gather the facts. Review the claim, legislation, Operational Blueprint, forms, evidence and customer information. Contact relevant stakeholders, if necessary. Some examples of how evidence can be gained by applying the REFLECT model could include getting supporting information: verbally after successful authentication in writing on additional documents from another core system, such as CDMS.
L - Linger at the fork in the road	Do I need help before deciding?	Pause before acting. Is something unclear, high risk or unusual? Make a clear evidence-based decision by analysing the information provided. Only where the decision is genuinely outside of a service officer's delegation, authority or experience should support be requested.
E - Evaluate options	What are the possible actions? Would the decision stand up to scrutiny or independent review?	Consider the risks, impacts and policy basis for each option. Assess different choices and their implications using resources such as the Operational Blueprint, relevant legislation and policies Discard unrealistic options and apply an accountability test.
C - Come to a decision	What is the best supported decision?	Choose the option that is ethical, evidence-based and consistent with policy and legislation. Document the decision and actions taken.
T - Take time to reflect	What did I learn and what should I record? How did it turn out for all concerned? What, if anything, should be done differently next time?	Review the decision's impact Confirm it remains justified by the evidence Identify lessons learned or improvements for future applications

REFLECT example scenarios

Example 1

A service officer receives a work item in Work Optimiser, an insurer emailed the agency to notify of a settlement. Attached to the email is a Notice of judgment or settlement form (MO022), a Settlement Agreement and a remittance advice showing that they have paid 10% of the total settlement.

Table 2

REFLECT step	Action
RE - Recognise the issue	The service officer sees that the MO022 is missing the: notifiable person's details at Question 22 and date of judgment or settlement (DOJS) at Question 26.
F - Find information	The service officer reviews Operational Blueprint (OB) and legislation. Legislation states that the notifiable person’s details are mandatory on the notification but does not say how to provide it. OB states that supporting documents can be used to get their details. OB states that although the DOJS is not mandatory, it is essential for processing of the claim.
L - Linger at the fork in the road	The service officer identifies that the notifiable person’s name and address is available on the Settlement Agreement. However, the address provided is a DX address (document exchange). A phone number was provided under the signature on the email the documents were attached to.
E - Evaluate options	The service officer considers options to get all necessary details not provided on the form making a phone call to the notifiable person or issuing a Z2802 letter requesting the details
C - Come to a decision	The service officer decides they are unable to issue the letter as the address on the Settlement Agreement is a DX address. The service officer calls the notifiable person using the number provided on the email signature. The notifiable person provides an appropriate postal address and correct DOJS. The date of the phone call is used as the notification date on the NOJS capture; this is the date when all necessary information was received.
T - Take time to reflect	The service officer reflects that calling the notifiable person was an appropriate, evidence-based action that ensured timely and accurate information was received to progress the claim.
Record the decision made	The service officer records a clear case note that explains: The REFLECT model was used What decision was made What evidence was considered Why the evidence supports the decision Any OB or interim process requirements considered For example: NOJS, Settlement Agreement and remit received from NP. Missing NP details at Q22, DOJS also missing. Settlement Agreement has NP name as first defendant with DX address noted. Applied the REFLECT model and accepted MO022 form based on following: Pt NP using number on email, spoke with John S. They confirmed correct postal address as PO Box 123, Suburb, State. 2123. Requested DOJS, they confirmed dd/mm/yyyy. Added details to claim. Located money, Doc date: dd/mm/yyyy Amount: $xx,xxx.xx Doc number: 601xxxxxx Insurer 9000#: 9000xxxx Allocation change sent to Finance, NTC issued

Example 2

A service officer receives a work item in Work Optimiser, on 28 June 2026, an MO022 is allocated for processing. The MO022 was received by email on 19 June 2026 but is missing the notifiable person’s address at Q22. The letter that accompanied the MO022 notes the same claim number and provides details of the notifiable person.

Table 3

REFLECT step	Action
RE - Recognise the issue	The service officer identifies that the MO022 form received on 19 June 2026 is incomplete - it is missing the notifiable person's address at Question 22.
F - Find information	The service officer notes the email, that the MO022 was attached to, has the same claim reference as Q22 on the MO022, verifying they relate to the same claim. The service officer checks Operational Blueprint (OB) - it confirms what qualifies as 'supporting documents' for the purpose of accepting the MO022 Legislation - states that the notifiable person's address details must be provided in writing but does not say how to provide it
L - Linger at the fork in the road	The service officer identifies that both a cover letter attached to work item and the email has the business address in the Claims Officer’s signature block.
E - Evaluate options	The service officer evaluates whether the cover letter and email can be treated as supporting documentation to validate the 19 June 2026 date of receipt against the OB definition. Options include two possible receipt dates: 19 June 2026 - the date the documents were received 28 June 2026 - the date the work item was received
C - Come to a decision	The service officer concludes that the cover letter and email do not qualify as supporting documentation, but are supplementary written information. The service officer decides to accept the MO022 as valid with the receipt date of 19 June 2026, as this is the date that all of the required information was provided by the notifiable person. The decision does not override or bypass the process by backdating validity without proper supporting documentation.
T - Take time to reflect	The service officer reflected that accepting the MO022 was an appropriate, evidence-based action, confirming 19 June 2026 is correct given all of the relevant information was provided on this date. This ensured accurate information was used to make a defensible decision, allowing for the claim to progress with all information requirements met.
Record the decision made	A clear case note is to be recorded that explains: The REFLECT model was used What decision was made What evidence was considered Why the evidence supports the decision Any OB or interim process requirements considered For example: NOJS, Settlement Agreement and cover letter received from NP. Missing NP address details at Q22. Applied the REFLECT model and accepted MO022 form based on following: Cover letter and email has same reference and contact person/business details as MO022, NP address is provided on letter and signature block of email. Letter and email are supplementary information, able to be accepted for purpose of NP’s address and can confidently confirm details match across all documentation and match claim. Added details to claim. Located money, Doc date: dd/mm/yyyy Amount: $xx,xxx.xx Doc number: 601xxxxxx Insurer 9000#: 9000xxxx Allocation change sent to Finance, NTC issued

Example 3

A service officer receives a work item in Work Optimiser on 4 August 2026, an MO022 is allocated for processing. The MO022 was received by email on 28 July 2026 with Deed of Release. The injured person's address is missing from Question 6 on the MO022.

Table 4

REFLECT step	Action
RE - Recognise the issue	The service officer identifies that the: MO022 form received on 28 July is incomplete - it is missing the injured person's address at Question 6 Deed of Release does not provide the injured person's address MO022 form is unable to be accepted as valid at the current time
F - Find information	The service officer reviews the work item to see if any other documents provide the injured person’s address, there were none. The service officer checks Case notes - which indicate that the injured person has contacted several times requesting a status update and asking about their refund Legislation - it states that the notifiable person's address details must be provided in writing but does not say how to provide it. Operational Blueprint to see if supplementary documentation with the missing information can be used to support the acceptance of the MO022 Rather than reject the form outright, the service officer directly contacted the Claims Officer whose details had been provided on the MO022. The service officer spoke with the Claims Officer and requested verbal confirmation of the injured person’s address. The Claims Officer provided an address that matches the one held by the agency. When asked, the Claims Officer advised that the information was located on a claim form signed by the injured person.
L - Linger at the fork in the road	The service officer paused to consider what affects further delays may have on the injured person and the claim, and whether the decision to accept the MO022 with the additional provision of the injured person’s address falls within requirements under legislation and policy.
E - Evaluate options	The service officer evaluated whether verbal confirmation would be acceptable or whether written confirmation would be required. The service officer asked the Claims Officer if they would send an email or amended MO022 confirming the injured person’s address while on the phone. The Claims Officer was happy to do this.
C - Come to a decision	The service officer decides to accept the MO022 with the additional information as valid applying the receipt date of 4 August 2026. This date is based on the phone confirmation and receipt of written confirmation by email and is the date that all of the required information was provided by the notifiable person. The decision does not override or bypass the process and provides proper supporting documentation and confirmation of required information.
T - Take time to reflect	The service officer reflected that accepting the MO022 was an appropriate, evidence-based action, confirming 4 August 2026 is correct given all of the necessary information was provided on this date. This ensured accurate information was used to make a defensible decision, allowing for the claim to progress without delay and with all information requirements met.
Record the decision made	A clear case note is to be recorded that explains: The REFLECT model was used What decision was made What evidence was considered Why the evidence supports the decision Any OB or interim process requirements considered For example: NOJS, Settlement Agreement and cover letter received from NP. Missing IP address details at Q6. Pt to NP, spoke with Jane S. Jane confirmed IP address as per claim, confirmed from a claim form signed by IP. Applied the REFLECT model and accepted MO022 form based on following: Requested an email or amended NOJS to be emailed while on phone, Jane sent email immediately confirming IP address in writing. Located email and attached to claim. Email is supplementary information, able to be accepted for purpose of IP’s address. Can confidently confirm details match IP’s current address on claim. Added details to claim. Money already allocated to WIN. Doc date: dd/mm/yyyy Amount: $xx,xxx.xx Doc number: 601xxxxxx Insurer 9000#: 9000xxxx Captured NOJS, processed SBC and refunded to IP via EFT as per MO024 on claim.

FAQs for forms

Table 5

Question	Answer
A valid MO022/MO026/MO027 is received and there is no claim registered. Should the claim be registered?	Yes. Due to arrival of correspondence, the claim needs to be registered and the NTC issued.
An invalid MO021/MO022/MO026/MO027 is received and there is no claim registered. What steps should be taken?	Claim is to be registered as a 'provisional claim' and issue a letter requesting the missing information. See Process Correspondence
A valid MO026 (notice of past benefits request) is received with an invalid MO021 (Third party authority). What steps should be taken?	If no claim is registered and the MO026 was signed by the injured person/claimant, the claim can be registered as an active standard claim and the NTC issued directly to the injured person/claimant. Contact to be made with the sender of the documents advising that the MO021 form was invalid. If no claim is registered, claim is to be registered as a provisional claim and issue a z2802 letter requesting the missing information. When a valid MO021 is received re-declared (that is re-signed and re-dated) copy of the MO026 is not required to be received with the updated MO021 form. The claim can proceed using the initial valid MO026 and the updated valid MO021. If there is an existing claim with an existing valid MO021 on the claim from the same authorised third party, proceed as per normal processing of NTC issue.
An MO026 is received for an existing claim. There is no indication of a of a settlement or reimbursement. Should a notice to claimant be issued?	Yes, when the previous NOPB has expired Service Officers can issue a new notice to claimant.
An invalid MO026 is received and there is an existing claim. Should a letter be issued?	Yes, issue a Z2802. A NTC should not be issued until a valid MO026 is received.
An MO026 & MO021 are received, and there is an existing claim and authority on file. What action is to be taken?	If the authorised third party (ATP) named on the new documents match the existing claim, proceed as normal and issue a NTC if the previous NOPB has expired. If the ATP named on the new valid form is different to the one on the record, contact the injured person to confirm that the previous ATP is no longer acting for the injured person on the claim. Once confirmed, update the record to add the new authority. If the claim has had a previous notice of past benefits issued which has expired, process the request and issue an updated NTC to the ATP.
An MO026 is received and there is evidence of a settlement or reimbursement arrangement. What action is required?	If the NOJS or NORA has been processed, an NTC should have already been processed; a new one is not needed. The new MO026 can be added to the claim as a ‘Notice of past benefits request’ document when processing the enquiry case. MCRS will recognise it is not needed and a pop up will announce that no further action is required at this time.

Forms

See Forms table in Medicare Compensation Recovery for a list of Medicare Compensation Recovery forms and descriptions.

Signature variation guide

Table 6: The table is a simple guide of illustrative scenarios and is not an exhaustive list of exact scenarios.

Example	Accept	Reject
First and last name provided on MO022/MO027 with signature and signature date.	X
Deed of Release contains full name (John Smith) and signature of notifiable person that matches the MO022 declaration.	X
First name and initial of last name provided on MO022/MO027 with signature and signature date. For example, John S. Email page sent from notifiable person’s business email address contains full name in email address For example, John.Smith@notifiable.com.au OR J.Smith@notifiable.com.au	X
MO022/MO027is received in isolation. The declaration has the name of notifiable business in name field with an unrecognisable signature provided and signature date. There is no supporting document provided and the email has a generic business signature.		X
First name, initial of last name provided on MO022 with signature and signature date. For example, John S Contact person's full name provided at Q22 and matches the shortened name on declaration.	X
Business name of notifiable person provided on MO022/MO027 with signature of representative, for example John S, and signature date. Contact person's name (may only be first name and last initial) provided at declaration Email page sent from notifiable person’s business email address contains name in email address For example, John.S@notifiable.com.au.	X
Signature provided on MO022/MO027 using electronic signature software, such as DocuSign. The electronic signature shows the full name. Full name not provided separately in box above signature.	X
First initial, initial instead of last name provided on MO022/MO027 with signature. For example, J S This cannot be confidently matched to any supporting document.		X

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Document Assessment - Medicare Compensation Recovery 011-15010000