Notice of past benefits (NOPB) and Notice of charge (NOC) - Medicare Compensation Recovery 011-15030010

An NOPB or NOC provides the total recoverable amount for a compensation claim.

An NOPB is valid for 6 months from the date of issue. The NOPB is not payable unless:

• it is valid on the date the compensation amount is fixed, or
• the claim reaches a judgment or settlement and a valid Medicare Compensation Recovery Section 23A statement (MO023) is submitted and accepted, extending the expired notice

A NOC never expires and is payable within 28 days of the date of the notice.

After Services Australia receives an SBC or if the time to return the statement has passed, MCRS will issue to the:

• notifiable person:
• The Notice of past benefits or charge or Notice of past benefits or charge - all services taken (Z2807) letter before judgment or settlement, or
• The Notice of charge (Z2811) letter after judgment or settlement, or
• No more correspondence if the agency has accepted a valid advance payment (AP)
• injured person or claimant:
• A copy of the Z2807 or Z2811 letter that was sent to the notifiable person on behalf of the injured person, or
• The Notice of past benefits - advance payment (Z2811) letter if the agency has accepted an AP

Note:

• if the agency accepts an AP, the notifiable person no longer has authority to access information about the claim
• if a valid Third Party Authority (MO021) form has been received and the authorised third party (ATP) has been added to the claim, a copy of all correspondence is sent to the ATP on behalf of the injured person

See Payments, refunds and debts.

If an SBC was returned by the due date and is substantially correct, a list of the verified Medicare benefits is attached to the notice.

See Statement by claimant (SBC) - Medicare Compensation Recovery.

If a statement is returned late, the agency may elect to process it as if it was received on time, provided that processing of an all services included NOPB or NOC has not yet happened.

Note: if the care cost question is ticked:

• No:
• A care cost check will not be performed, or
• If any amount exists on a previous NOPB it will be carried forward
• Yes:
• A calculation is done and any amount would be included on an initial NOPB, or
• Potentially increased on a subsequent NOPB

See Extensions, decisions and reviews - Medicare Compensation Recovery.

If a complete SBC was not returned by the due date on the Notice to claimant (NTC), either a Notice of charge - all services included (Z2811) letter or a Notice of past benefits - all services included (Z2807) letter is issued by MCRS, unless:

• the claim has reached judgment or settlement and a valid Section 23A statement has been received and accepted, in conjunction with notification of a settlement, or
• an extension was granted and the due date has not yet passed, or
• a Statement not substantially correct (Z2805) letter is issued by MCRS within the required time frames, and the due date has not yet passed

All services listed on the NTC will be taken as related to the claim. All nursing home benefits, residential care subsidies and home care subsidies (care costs) identified in a previous notice of past benefits will be carried forward.

An additional care costs check is not needed as any potential increase in costs cannot be considered as relating to the claim.

When issuing a Notice of past benefits or charge - all services taken (Z2807) notice, the list of Medicare benefits is not attached. The notice provides the total amount of all benefits listed on the NTC.

The Health and Other Services (Compensation) Act 1995 prescribes a 3 month time frame for the agency to issue a NOC from the date of notification of a:

• judgment or settlement or receipt of the advance payment (AP); whichever is later, or
• judgment or settlement if no advance payment or ad-hoc payment is received, or
• reimbursement arrangement

The 3 month time frame may be extended for valid AP claims in certain circumstances. For example, granting an extension, or if a Statement not substantially correct (Z2805) letter is issued.

See:

• the References page, it contains sections 24(4), 25(4) and 33D of the Health and Other Services (Compensation) Act 1995 for more details
• the Resources page, it contains relevant issuing timeframes and how to calculate them
• Extensions, decisions and reviews - Medicare Compensation Recovery
• Payments, refunds and debts - Medicare Compensation Recovery for payment criteria

Where no valid NOPB exists and no completed Section 23A statement has been received at the time of judgment or settlement, a Notice to claimant (NTC) Z2800/Z2801 letter is sent to the injured person or claimant.

When accepting a Section 23A statement, the amount from the most recently expired NOPB relating to the claim, becomes the amount payable on the NOC. If there is no previous NOPB the charge amount becomes $NIL.

If there is no Section 23A statement and no current NOPB, dependent upon the stage that the claim is currently at, MCRS will either:

• issue an NTC
• wait for a recently issued NTC to be returned
• wait for the returned SBC to be processed, or
• wait for the due date to expire and raise the statement for deeming all services included

If the NTC was issued before receipt of the Notice of judgment or settlement (NOJS), MCRS will not issue another NTC unless critical details are changed. For example, a change to the date of injury.

MCRS will wait for the returned SBC for processing, or once the due date has lapsed will request a Service Officer to deem all services so the NOC can be issued.

If the SBC was returned before the NOJS but was incomplete, a Statement not substantially correct (Z2805) system letter is issued with a new due date for returning the SBC. MCRS refers to this extension date for including all services on the notice, if required.

Calculation of S33D due date for Notice of past benefits - advance payment (NOPB-AP) with no extension

Under section 33D of the Health and Other Services (Compensation) Act 1995, if an advance payment (AP) has been made that is compliant with section 33B (3), the date to issue a notice is 3 months from receiving the later of either:

• a complete and valid NOJS from the notifiable person, or
• the AP

Under section 33D of the Health and Other Services (Compensation) Act 1995, there are no amounts recoverable by the agency where:

• more than 3 months have passed since a complete NOJS and valid AP was received
• no extension was granted, and
• a NOPB-AP has not been issued

See Payments, refunds and debts - Medicare Compensation Recovery.

Calculation of S33D due date for NOPB-AP after an extension

If an extension was granted to return an SBC, the new section 33D date is 28 days after the new statement return date if the new statement return date is after the original section 33D(1) date. That is, 3 months after the date of receipt of NOJS or AP, whichever is later.

For example, if the section 33D (1) date was 2 April 2025, but the extension to return the statement was granted until 10 April 2025, an NOPB-AP must be issued by 8 May 2025. That is, 28 days after the new statement return date.

If an extension was granted to return an SBC, the section 33D date remains the same if the new statement return date is on or before the existing section 33D (1) date. That is, 3 months after the date of receipt of NOJS or AP, whichever is later.

For example, if the section 33D (1) date was 2 April 2025, but the extension to return the statement was granted until 30 March 2025, a NOPB-AP must still be issued by 2 April 2025. The original section 33D(1) date remains.

Calculation of S33D due date for NOPB-AP after incomplete statement received

If an SBC was incomplete and a Statement not substantially correct (Z2805) letter issued to the injured person or claimant, the section 33D date will either:

• remain unchanged. That is, 3 calendar months from notification/payment date, or
• be extended to 28 days after the agency gets the resubmitted statement and it is accepted as being substantially correct, whichever is later

Calculation of S24 (4) due date for NOC

Under section 24(4) of Health and Other Services (Compensation) Act 1995, where there has been no valid AP made the agency has a maximum of 3 months to issue a NOC to the notifiable person payer from the date a completed NOJS was received.

This date cannot be extended by:

• a not substantially correct decision, or
• granting an extension

If the section 24(4) date has passed and a NOC has not been issued, the agency will not recover any amounts. Any money received must be returned to the notifiable person, unless authorised to direct refunds to the injured person or claimant.

See Payments, refunds and debts - Medicare Compensation Recovery.

After a Section 23A statement is received

A Section 23A statement may be submitted by the injured person if they have not received any:

• Medicare benefits relating to the injury or illness compensated for, or
• further Medicare benefits relating to the injury or illness since the date of their latest expired NOPB

The amount payable on NOC or NOPB-AP with a section 23A statement will either be:

• the amount on the most recently expired notice of past benefits (NOPB), or
• $Nil

After an advance payment (AP) is received

The AP is credited against the recoverable amount, and an NOPB-AP is issued to the injured person or claimant. If there is:

• more than the AP amount owed to the agency, the amount is payable to the agency by the injured person within 28 days after receiving the notice, or
• a refund owed to the injured person or claimant, that amount is paid by the agency to the injured person. That is, unless the agency is directed to refund to another party by provision of supporting documents. For example, a court order directing a refund to the Public Trustee

See Payments, refunds and debts - Medicare Compensation Recovery.

After a failed AP or an ad-hoc payment amount is received

All money received that does not meet the criteria for an AP is considered to be an ad-hoc payment in MCRS. The ad-hoc payment amount is credited against the recoverable amount and a NOC is issued to the notifiable person. If there is:

• money outstanding, the amount is payable by the notifiable person
• a refund owed, the amount is paid to the nominated party as per direction provided by the notifiable person on the:
• Notice of Judgment or Settlement (NOJS) form, or
• relevant supporting documents

Notice of reimbursement arrangement (NORA)

Where a notifiable person has notified the agency of a reimbursement arrangement, a new Notice to claimant (NTC) is issued unless a recent one has been issued or an NOPB is current. If a statement by claimant (SBC) is:

• returned by the due date, or before processing:
• a NOC with an itemised list of services identified by the injured person or claimant will be issued to the notifiable person, with a copy to the claimant
• not returned:
• a Notice of charge - all services included (Z2811) letter is issued to the notifiable person. This notice does not have an itemised list attached

Percentage of apportionment

Where the injured person has been determined to have contributed to their injury or illness (contributory negligence), a percentage of liability is set at judgment or settlement. This is known as an apportionment, and it reduces the total settlement amount received by the injured person.

The NOC or NOPB-AP total amount owed to Medicare is reduced by the percentage of apportionment attributed to the injured person. For example, if the injured person were apportioned 20% liability, the recoverable amount is reduced by 20%.

Centrelink recovery amount

The Health and Other Services (Compensation) Act 1995 recognises Centrelink’s authority to recover amounts before Medicare. In a situation where the total compensation amount paid is not enough to cover both the Centrelink and the Medicare recovery amounts, the agency must reduce the Medicare NOC/NOPB-AP.

If the Centrelink recovery amount is provided, entering this amount into the MCRS reduces the amount that Medicare can recover.

MCRS calculates the maximum Medicare recovery amount by subtracting the Centrelink recovery amount from the total amount of compensation.

See Notice of judgment or settlement (NOJS) - Medicare Compensation Recovery

Judgment fixes the amount of past expenses

Where the past Medicare expenses are fixed by the court at the time of judgment, this fixed amount becomes the maximum amount recoverable by the agency.

Where the past medical expenses are fixed by the court at the time of judgment the amount payable to the agency will be determined by the services identified by the injured person on the SBC. If the NOC or NOPB-AP is greater than the fixed cost amount, the agency cannot recover more than the total fixed Medicare or medical expenses compensation amount.

See Notice of judgment or settlement (NOJS) - Medicare Compensation Recovery.

Administrative errors

If an administrative error is found on an NOPB:

• call the notifiable person and injured person/claimant or authorised third party, and
• tell them an updated notice will be sent as soon as possible

This will make sure correct information is used when negotiating the settlement or judgment amount and minimise future rework and extra enquiries.

If an administrative error is found on a NOC or NOPB-AP, it must be corrected as soon as possible to make sure the correct recovery amount and refund/debt is issued.

Note: When an injured person, claimant/authorised third party, or notifiable party requests a review due to incorrect service calculations or a claim has been closed in error, the NOC or NOPB-AP components may be adjusted and be either increased or reduced. These adjustments are assessed on a case-by-case basis. For example, if a claim was incorrectly closed as 24.4 or 33k, it may be reprocessed to generate the correct charge.

See Extensions, decisions and reviews - Medicare Compensation Recovery.

Amended NOPB, NOC or NOPB-AP requested

A request may be submitted to remove Medicare services and/or care services included on an NOPB, NOC or NOPB-AP. A copy of the most recently returned SBC including the declaration must be returned with:

• a letter from a treating medical practitioner, or
• a statutory declaration indicating that services previously selected on the statement by claimant do not relate to the compensated injury

See Extensions, decisions and reviews - Medicare Compensation Recovery.