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Statement by claimant (SBC) - Medicare Compensation Recovery 011-15030060

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Contact details

Medicare Compensation Recovery, use for:

  • Tier 1, 2 and 3 support, and
  • Medicare Compensation Recovery Team Leaders

Scenarios for accepting subsequent partially returned SBC’s

Table 1: outlines whether to accept a subsequent partial SBC in various scenarios. This is not an exhaustive list, if Service Officers are unsure contact Tier 1 support for assistance.

Scenario – initial SBC received

Actions by IP/Claimant in response to Z2805

Service Delivery Action

SBC returned - incomplete services statement due to missing pages, complete and valid care services statement, and complete and valid declaration page.

Or

SBC returned - incomplete services statement with all pages included however errors or unclear ticks making it invalid, complete and valid care services statement, and complete and valid declaration page.

In response to the Z2805, only the missing pages are returned.

In response to the Z2805, only the re-completed pages are returned.

Accept return of missing pages – previously returned pages do not need to be resent in this instance.

Accept return of completed services statement pages – previously returned care services statement and declaration page do not need to be resent in this instance.

SBC returned - complete and valid services statement with all pages included, complete and valid care services statement and incomplete or invalid declaration page.

In response to the Z2805, only the complete and valid declaration page is returned.

Accept return of completed declaration only – services statement pages and care services statement do not have to be returned in this instance.

SBC returned - complete and valid services statement with all pages included, incomplete and invalid care services statement, and complete and valid declaration page.

In response to the Z2805, only the complete and valid care services statement is returned.

Accept return of completed care services statement only - services statement pages and declaration do not have to be returned in this instance.

SBC returned - incomplete services statement due to missing pages, complete and valid care services statement, and complete and valid declaration page.

In response to the Z2805, the full SBC is returned with different services indicated on the services statement, complete and valid care services statement, and complete and valid declaration

Accept the most recent SBC as valid and complete for processing purposes.

Table 2: amendment request to Notice of past benefits (NOPB) Pre-settlement or Notice of past benefits - advance payment (NOPB-AP)/ Notice of charge (NOC) - Post settlement

Category

Actions

Amendment request to NOPB - Pre-settlement

The entire re-completed SBC must be returned. The SBC must be the most current Notice to claimant (NTC) issued.

SBC includes:

  • All pages of the services statement, and
  • Care services statement, and
  • Declaration that was issued as part of the NTC.

Refer to Incomplete or amended SBC for further information regarding amendments pre-settlement.

If the initial submission of the SBC for amendment is invalid, the entire valid SBC must be returned again before the amendment can proceed.

Amendment request to NOPB-AP or NOC - Post settlement

The entire re-completed SBC must be returned accompanied by medical evidence (for example, a letter from a treating medical practitioner) or a completed statutory declaration. The SBC must be the most current NTC issued.

SBC includes:

  • All pages of the services statement and
  • Care services statement and
  • Declaration that was issued as part of the NTC.

See Extensions, decisions and reviews - Medicare Compensation Recovery for more comprehensive information regarding amendments post-settlement.

If the initial submission of the SBC for amendment is invalid, the entire valid SBC and supporting evidence must be returned again before the amendment can proceed.