Extensions, decisions and reviews – Medicare Compensation Recovery 011-15030070

• For requests via the phone, go to Step 2
• For written requests, go to Step 3

If the claim is a legacy claim, see Search for or update an existing claim or register a new claim to migrate the claim first.

• Select Phone enquiry from the dropdown menu
• Select Have you authorised the caller and selected the relevant claim?
• Select Is an extension being requested?
• Select Continue

A message displays Have you entered a case note?

• Select yes if case note entered
• Select no if case note not entered. Enter case note and select Continue

A message displays Would you like to continue processing Statement by claimant (SBC) task or assign to the queue?

If the Service Officer is:

• proficient:
• select Keep assigned to me
• select Ok, go to Step 4
• not proficient:
• add a case note to document this process
• select Assign to the queue
• select Ok
• procedure ends here

If the claim is a legacy claim, see Search for or update an existing claim or register a new claim to migrate the claim first.

• Select Statement by claimant
• Select Does the claim selected match the details in the document?
• Select Is an extension to be processed?
• Select Continue

A message displays: Have you entered a case note?

• Select yes if case note entered
• Select no if case note not entered. Enter case note and select Continue

A message displays: Would you like to continue processing Statement by claimant (SBC) task or assign to the queue?

If the Service Officer is:

• proficient:
• select Keep assigned to me
• select Ok, go to Step 4
• not proficient:
• add a case note to document this process
• select Assign to the queue
• select Ok
• procedure ends here

Is the request for a reconsideration of decision?

• Yes,
• case to be completed by APS4 (or above). If transfer of case needed see Escalations
• see Table 3
• No,
• enter extension request received date
• the extension decision date defaults to today's date

If the request is:

• granted, select Do you grant the request?, go to Step 5
• refused, select Continue, go to Step 6

• New due date field displays and the new due date auto populates to 28 days after the original date
• Select Continue. Go to Step 6

Note: the due date can be manually amended if granting an extension of more than 28 days.

Extensions of more than 28 days can only be carried out when:

• a claim has settled and
• meets the valid Advance Payment (AP) criteria

The requestor must specify the time frame (must be within 12 months of the original due date), otherwise it must default to 28 days.

If the request is:

• granted:
• select the Notice type from the dropdown menu
• select Extension from the Letter purpose dropdown menu
• select the correct recipient and select Preview to view the letter content
• select Submit to issue the letter
• add a case note to document this process
• refused:
• select the Notice type from the dropdown menu
• select Extension from the Letter purpose dropdown menu
• select the relevant refusal reason
• select the correct recipient and select Preview to view the letter content
• select Submit to issue the letter
• add a case note to document this process

Procedure ends here.

• Select Statement by claimant or Notice of Past Benefits request from the dropdown menu
• Select Does the claim selected match the details in the document? button

Note: select the document type based off the document received, the options displayed will auto populate depending on the document type.

Is a Notice of refusal (z2806) needed?

• Yes,
• select Do you want to refuse to issue a NOPB? button
• select Continue
• a message displays Are you sure you want to refuse to issue a Notice of Past Benefits? or Are you sure you want to refuse to issue a Notice to claimant?, select Yes, go to Step 2
• No,
• select Do you want to issue a NTC? Button
• select Continue
  to issue NTC see Notice of past benefits request and notice to claimant. To process SBC see Statement by claimant and care costs.

• injured person, claimant or Authorised third party (ATP), go to Step 3
• notifiable person or their solicitor, go to Step 4

Is the request for a reconsideration of decision?

• Yes,
• case to be completed by APS5 (or above)
• if transfer of case needed see Escalations
• see Table 4
• No,
• select Notice of refusal from the dropdown menu
• select the relevant refusal
• if Failed to submit the statement within 2 years from DOJS reason is selected, additional fields appear:
  enter Date request was received
  enter Settlement date
• select the correct recipient (the party requesting the notice) and select Preview to view the letter content
• select Submit to issue the letter
• add a case note to document this process
• procedure ends here

• Select Skip Correspondence button.
  Note: Skip correspondence is used at this step, only for a subsequent request from the notifiable person or their solicitor after a previous one has been actioned. This is to reduce unnecessary requests for further information regarding the refusal letter
• Select Submit
• Message displays Are you sure you want to proceed skipping the correspondence?, select Yes
• Add a case note to document this process
• Procedure ends here

Only an APS4 (or above) can action a reconsideration of decision.

Select the WIN hyperlink from the left-hand summary panel within the work item to assess the claim fully.

Review all case notes, previous decisions made, correspondence issued and documents received to make a determination of:

• substitution,
• variation, or
• affirmation

When reviewing an extension decision:

• select Statement by claimant (SBC) from the dropdown menu
• select Does the claim selected match the details in the document? button
• select Is an extension to be processed? button
• select Continue

A message displays Have you entered a case note? Would you like to continue processing Statement by claimant task or assign to the queue?

If the Service Officer is:

• proficient and has an APS4 (or above) delegation:
• select Keep assigned to me
• select Ok, go to Step 3
• not proficient or has an APS3 (or below) delegation
• select Assign to the queue
• select Ok
• add a case note to document this process
• procedure ends here

Extension request received date defaults to the original extension received date.

If the review decision is:

• substituted or varied
• select Do you grant the request? button
• select Submit
• go to Step 4
• affirmed
• do not select the Do you grant the request? button
• select Submit
• go to Step 4

• Select the form type (document received) from the dropdown menu
• Select Extension from the Letter purpose dropdown menu
• Select Review decision from the dropdown menu
• Select Original extension decision from the dropdown menu
• Select the relevant reason for the decision
• Select the correct recipient (the party requesting the extension) and select Preview to view the letter content
• Select Submit to issue the letter
• Add a case note to document this process
• Procedure ends here

Select the WIN hyperlink from the left hand summary panel within the work item and review:

• the documents received and correspondence issued
• the case note, and
• other relevant resources

Assess the claim fully (see to Background - Review of decision -Notice of refusal) and make a determination of:

• affirmation, or
• variation

• select Statement by claimant or Notice of Past Benefits request from the dropdown menu
• select Does the claim selected match the details in the document? button

Note: select the document type based off the document received, the options displayed will auto populate depending on the document type.

Is review of a decision needed?

• Yes,
• select Do you want to refuse to issue a NOPB? button
• select Continue
• a message displays Are you sure you want to refuse to issue a Notice of Past Benefits? or Are you sure you want to refuse to issue a Notice to claimant?, select Yes, go to Step 3
• No,
• select Do you want to issue a NTC? button
• select Continue
• to issue NTC see Notice of past benefits request and notice to claimant. To process SBC see Statement by claimant and care costs

• an injured person, claimant or Authorised third party (ATP), go to Step 4
• a notifiable person or their solicitor, go to Step 5

If the refusal to issue a notice is for a Notice of past benefits (NOPB), the NOPB will default to become the Notice of charge (NOC) if a valid settlement document is received.

From the Heading dropdown menu select Review of decision.

From the Decision type dropdown menu select either Affirmed or Varied:

• Affirmed (to uphold the original decision)
• Enter Date request was received and Settlement date
• Preview the letter
• Select Submit to issue the letter
• Varied (to accept presented reasoning or evidence to change original decision)
• Preview the letter
• Select Submit to issue the letter
• Add a case note to document this process
• Procedure ends here

• Select Skip Correspondence button
• Select Submit
• Message displays Are you sure you want to proceed skipping the correspondence?, select Yes
• Add a case note to document this process
• Procedure ends here

• Select Notice of Judgment or Settlement from the dropdown menu
• Select Does the claim selected match the details in the document? button

Note: amendments to care costs can only be completed by an APS5 (or above).

Is the Service Officer proficient with an APS5 (or above) delegation?

• Yes, see Table 2 in Statement by claimant and care costs to process Care Costs
• No,
• select Save and close the enquiry using the X in the summary panel
• add a case note to document this process. Include what the customer is seeking and any evidence supplied
• go to Step 2

In Work Optimiser:

• select the appropriate work item from Work Items
• select Actions
• select Reassign
• select Recategorised from the Reason box
• enter MCRS_SBC_CC_NOPB if SBC was the document received or MCRS_SBC_CC_NOJS if NOJS was the document received as the Work Type
• select Submit
• procedure ends here

When an amendment to the Notice of charge (NOC) is needed due to a Centrelink recovery:

• select Is any amount payable to Centrelink button
• enter the correct amount
• select Continue

Confirm payment details in SAP are entered into MCRS:

• search SAP
• update appropriate details as required
• select Continue

Review data entered:

• select Edit to change any details, if required
• select Submit

Note: the NOC summary screen will display. A review will be needed before the issue of the amended NOC.

Complete the Referring a case to compensation finance email template with details:

• the NOC has been amended due to Centrelink recovery and
• the debt and/or refund are to be corrected

Add a case note to document this process.

Procedure ends here.

Different messages will display depending on how the original claim was closed:

• Claims that closed under 24(4), 25(4) or 33K will show:
• Claim closed under s24(4), s25(4) or s33K. Are you sure you want to reopen the claim?
• Claims that did not close under one of the above conditions will show:
• Selected WIN is closed. Are you sure you want to reopen and update the claim details?”

Select Yes to continue.

If NOJS was selected from the dropdown menu, the NOJS Capture screen will display

• See Table 1 in Notice of judgement or settlement (NOJS). Go to Step 3.

If NORA was selected from the drop down menu, the NORA Capture screen will display

• See Table 1 in Notice of reimbursement arrangement (NORA). Go to Step 4.

Make sure all fields are updated as required.

The most recent NOPB will display.

Complete SAP searches for any additional money that may have been received after the claim was initially closed.

If an amount was:

• received previously and added to the claim, continue with this Step
• not received previously and not added to the claim, the Has any amount been received for this claim in SAP button will be deselected

Was an additional payment located?

• Yes,
• select the ‘Has any amount been received for this claim in SAP’ button. Do not add payment amounts to these fields
• add additional payment by selecting the ‘Any additional payment received’ button, enter payment details into the additional payment fields
• select Continue
• on the review screen, check all details for accuracy
• select the Reprocess SBC details and issue NOC button
• select Submit
• reprocess SBC details question presents. Select yes
• go to Step 5
• No, go to Step 5

Confirm that details in the Review screen are correct.

Do services or care costs require amendment?

• Yes, select the ‘Reprocess SBC detail and issue NOC’ button. Go to Step 5
• No, select Submit. Go to Step 6

Make required amendments to the Capture SBC details screen to match the amended service details provided, or as per approval by APS5 Service Officer or Program Management.

See Statement by claimant and care costs to process the SBC.

The claim does not need to be escalated for care cost checks if:

• care costs are shown on the care cost statement of the SBC being used to request an amendment, but
• the NOC being amended does not include a care cost charge

No component of a valid charge used to finalise a claim can be increased.

Does the NOC need an amendment to decrease the care cost amount?

• Yes,
• select the ‘Are care services involved or a care costs breakdown required?’ button for escalation to an APS 5 (or above)
• select Submit
• procedure ends here
• No,
• after finalising the SBC capture
• select Submit. Go to Step 6

Complete SAP searches for any additional money that may have been received after the claim was initially closed.

If an amount was:

• received previously and added to the claim, continue with this Step
• not received previously and not added to the claim, the Has any amount been received for this claim in SAP button will be deselected

Was an additional payment located?

• Yes,
• select the ‘Has any amount been received for this claim in SAP’ button. Do not add payment amounts to these fields
• add additional payment by selecting the ‘Any additional payment received’ button, enter payment details into the additional payment fields
• confirm the information is correct
• select and turn on the ‘Is S23A and Advance Payment details verified?’ button
• select Submit
• No,
• confirm the information is correct
• select and turn on the ‘Is S23A and Advance Payment details verified?’ button
• select Submit
• go to Step 7

Are the details correct?

• Yes,
• select Submit to issue the NOC
• add a case note to document this process
• No,
• select Back and correct details
• add a case note to document this process

Is the refund/debt over the $50,000.00 threshold?

• Yes, do not complete the Referring a case to Compensation Finance template. When the quality checking is completed the quality checker will send the notification to Finance
• No, complete the Referring a case to compensation finance email template informing them that the NOC has been amended

Procedure ends here.

Different messages will display depending on how the original claim was closed.

Claims that closed in CCMS will not show that they closed under 24(4), 25(4) or 33K.

Has the claim been migrated?

• Yes, see Table 1 in Close, terminate or reopen a claim and then go to Step 2
• No, see Table 2 in Claim management and then go to Step 2

• If NOJS was selected from the dropdown menu, the NOJS Capture screen displays:
• See Table 1 in Notice of judgement or settlement (NOJS). Go to Step 3
• If NORA was selected from the dropdown menu, the NORA Capture screen displays:
• See Table 1 in Notice of reimbursement arrangement (NORA). Go to Step 4

Make sure all fields are updated as required.

The most recent NOPB will display.

The S23A button will be visible but cannot be selected or amended.

Complete SAP searches for any additional money that may have been received after the claim was initially closed.

If an amount was:

• received previously and added to the claim, continue with this Step
• not received previously and not added to the claim, the Has any amount been received for this claim in SAP button will be deselected

Was an additional payment located?

• Yes,
• select the ‘Has any amount been received for this claim in SAP’ button. Do not add payment amounts to these fields
• add additional payment by selecting the ‘Any additional payment received’ button, enter payment details into the additional payment fields
• select Continue
• No,
• select Continue
• go to Step 5

Confirm that details in the Review screen are correct.

Do services or care costs require amendment?

• Yes, select the ‘Reprocess SBC detail and issue NOC’ button. Go to Step 5
• No, select Submit. Go to Step 6

Make required amendments to the Capture SBC details screen:

• to match the amended service details provided, or
• as per approval by APS5 Service Officer or Program Management

See Statement by claimant and care costs to process the SBC.

The claim does not need to be escalated for care cost checks if:

• care costs are shown on the care cost statement of the SBC being used to request an amendment, but
• the NOC being amended does not include a care cost charge

No component of a valid charge used to finalise a claim can be increased.

Does the NOC need an amendment to decrease the care cost amount?

• Yes,
• select the ‘Are care services involved or a care costs breakdown required?’ button for escalation to an APS 5 (or above)
• select Submit
• procedure ends here
• No, after finalising the SBC capture, select Submit. Go to Step 6

Complete SAP searches for any additional money that may have been received after the claim was initially closed.

If an amount was:

• received previously and added to the claim, continue with this Step
• not received previously and not added to the claim, the Has any amount been received for this claim in SAP button will be deselected

Was an additional payment located?

• Yes,
• select the ‘Has any amount been received for this claim in SAP’ button. Do not add payment amounts to these fields.
• add additional payment by selecting the ‘Any additional payment received’ button, enter payment details into the additional payment fields
• confirm the information is correct
• select and turn on the ‘Is S23A and Advance Payment details verified?’ button
• select Submit
• No,
• confirm the information is correct
• select and turn on the ‘Is S23A and Advance Payment details verified?’ button
• select Submit
• go to Step 7

Are the details correct?

• Yes,
• select Submit to issue the NOC
• add a case note to document this process
• No,
• select Back and correct details
• add a case note to document this process

Is the refund/debt over the $50,000.00 threshold?

• Yes, do not complete the Referring a case to Compensation Finance template. When the quality checking is completed the quality checker will send the notification to Finance
• No, complete the Referring a case to compensation finance email template informing them that the NOC has been amended

Procedure ends here