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Escalations - Medicare Compensation Recovery 011-15040000

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This document outlines the escalation process for staff who need to escalate work items to staff with the appropriate MCRS delegations or skill tags, and how to review hardship claims for priority processing.

On this page:

Escalate a claim

Re-categorising of work items for untrained staff

Escalate a claim

Table 1: this table outlines how to unassign and re-categorise a work item for escalation in Work Optimiser - Health

Step

Action

1

Unassign a work item + Read more ...

Before escalating a work item, it must be unassigned. This is done in Work Optimiser - Health, on the My Work page:

  • select the Work Item ID (tick the box)
  • select Actions from the bottom right of the screen
  • select Unassign

2

Re-categorise work item + Read more ...

To re-categorise the work item for escalation:

  • select Reason: Re-categorised
  • select Work Type escalation options:
    • MCRS_PRIORITY_SO4 for priority processing
    • MCRS_REVIEW_EXT for review of extension decision by an APS4
    • MCRS_REVIEW_REFUSAL for review of a refusal decision by an APS5
  • select Submit

Note: work should not be re-categorised to SO4 priority unless exceptional circumstances exist.

If a Service Officer receives a work item that they are not trained in, escalate to relevant work type through Workload Manager see Table 2

3

Evaluating work items for escalation to APS5 or Program Management + Read more ...

To refer a claim to an APS5 or Program Management:

  • open the enquiry. See Claim Management to assist with evaluation
  • evaluate all information on the claim, assess all documents and read all case notes
  • if the Service Officer needs assistance with decisions on a claim, select the button relevant to level of delegation required, APS5 or Program Management
  • complete a case note
  • save the case note on the template on the claim, see Table 6 of Claim Management - Medicare compensation recovery
  • select Submit

Note: Service Officers do not need to send an email to Program Management.

4

Program Management - returning work item to Service Delivery + Read more ...

When a claim is escalated to Program Management for advice, a Program Officer is required to:

  • evaluate the claim based on documents and case notes provided
  • assess the escalation based on the request for advice from Service Delivery
  • open the case notes template, refer to the Escalations menu and select the case note marked Program Management use only
  • copy the text from the template and paste into case notes, edit as applicable.
  • save the enquiry

To send the item back for completion by a Service Officer:

  • unassigning the work item
  • re-categorise work item Select MCRS_PRIORITY_SO4 for priority processing
  • Select Submit

Re-categorising of work items for untrained staff

Table 2: this table outlines how to unassign and re categorise a work item when the work is outside the training of the Service Officer

Step

Action

1

Unassign a work item + Read more ...

Before re categorising a work item it must be unassigned.

In Work Optimiser - Health, on the My Work page:

  • Select the Work Item ID (tick the box)
  • Select Actions from the bottom right of the screen
  • Select Unassign

2

Re-categorise work item + Read more ...

To re categorise the relevant work type through Workload Manager:

  • Select Reason: Re-categorised
  • Select Work Type to select according to the document type:
    • MCRS_DOC_ASS_MO026 - Notice of past benefits request
    • MRCS_DOC_ASS_MO026 - Third Party authority
    • MRCS_DOC_ASS_MO022 - NOJS document assessment
    • MRCS_DOC_ASS_MO027 - Notice of reimbursement arrangement
    • MRCS_DOC_ASS_MO023 - Section 23A Statement
    • MRCS_DOC_ASS_MO024 - Injured person's bank account details
    • MRCS_DOC_ASS_MO025 - Compensation payer's account details
    • MRCS_DOC_ASS_MO028 - Medical services and care costs declaration
    • MRCS_DOC_ASS_Z2801 - Statement by claimant
    • MRCS_DOC_ASS_Z2245 - Statement by claimant Z2245
  • Select Submit

Note: if a trained Service Officer is processing SO4 priority work items, and an unclassified item has been re-categorised in error. It must be re-categorised to the appropriate queue according to the incoming correspondence work item.