Close, terminate or reopen a claim - Medicare Compensation Recovery 011-15040040

• Select the button for the relevant work item number (WIN). The View compensation details screen can be opened using the WIN hyperlink
• Select Continue

Select document type Notice of Reimbursement Arrangement or Notice of Judgment or Settlement from the dropdown menu:

• Other - all other document, go to Table 2
• Notice of Reimbursement Arrangement* (NORA)
• Notice of Judgment or Settlement* (NOJS)
• Phone enquiry, go to Table 2

Note: either a Notice of Reimbursement or Notice of Judgment or Settlement workflow will display depending on which document type is applied to the claim. If an amendment to the Notice of charge (NOC) is needed due to receipt of a Statement by claimant (SBC) select NORA or NOJS and the workflow will provide the option to reprocess a SBC.

Select the relevant button to confirm:

Does the Medicare customer selected match the injured person named in the document?

Does the claim selected match the details in the documents?

• Yes, select the button. This must be selected to be presented with additional questions which will provide further actions on the claim. The claim can be escalated to Program Management or SO5 from this point
• No, select the Check existing compensation link. Use Advanced Search to locate relevant claim

Are the documents received incomplete?

• Yes, select the button. A pop-up will present with Are you sure you want to send correspondence and close enquiry?, select Yes. Select the Form type that was unable to be processed, the Reason and the Recipient. Select Submit. The process ends here
• No, leave button off and proceed

Is this duplicate correspondence?

• Yes, select the button. Select from the drop down menu who initiated update to closed claim, Customer or Service Officer. Leave a case note, select Duplicate button. A pop-up will present asking Did you add a case note? select Yes. The process ends here
• No, leave button off and proceed

Do you want to send refusal letter?

Yes, select the button. Select from the menu who initiated update to closed claim, Customer or Service Officer. Select Continue. A pop-up will present asking Are you sure you want to send refusal latter & close enquiry? Select yes. From Set correspondence screen, select heading:

• Notice of refusal, select Reason, Preview Z2806 letter. Select Submit
• Invalid request for review, Preview Z2806 letter. Select Submit
• Review of decision, select decision type:
• Affirmed, enter date request received and date of judgment or settlement
• Varied, Preview Z2806 letter. Select Submit

No, leave button off and proceed

Note: the recipient of the Z2806 letter will default to claimant if there is one on the claim, otherwise it will default to injured person.

Is an update to existing contact details required?

Yes,

• Select the button
• Select from the dropdown menu who initiated update to closed claim
• Customer, or
• Service Officer
• Select Continue
• A pop-up will present asking Are you sure you want to update the contact details of this claim? Select Yes
• Proceed through the Capture injured person details, Capture claimant details and Capture notifiable person details screens to update relevant contact information
• Review updates and select Submit

Note: if staff select this option after selecting NOJS or NORA in the document type, the claim will flow into the update process before proceeding to the Capture NOJS or Capture NORA screen

• Select from the dropdown menu who initiated the update to a closed claim:
• Customer, or
• Service Officer

Does the claim need Program Management advice or action? (For example, requested amendment of notice or care costs after settlement)

• Yes:
• Leave a case note explaining why the claim has been escalated
• Select the Escalate to PM button
• The process ends here
• No, Select Reopen
• A message displays Selected WIN is closed. Are you sure you want to reopen and update the claim details?
• If the claim does not need to be reopened, select No to return to the Evaluate screen
• To reopen the claim, select Yes

For Process Steps to update the claim and reprocess the NOJS (depending on what document was used to close the claim), see:

• Notice of judgment or settlement (NOJS), or
• Notice of reimbursement arrangement (NORA)

Note: a Referring a claim to Compensation finance email template is needed when a claim is reopened and any action taken which results in a change to the NOC, NOPB-AP, refund or debt. The EFT to Finance (valid advance payments) SharePoint form must not be used for reopened claims.

• Select the button beside the correct work item number (WIN). The View compensation details screen can be opened using the WIN hyperlink
• Select Continue

Select document type from the dropdown menu:

• Other - all other document types, go to Step 3
• Notice of Reimbursement Arrangement*, go to Table 1
• Notice of Judgment or Settlement*, go to Table 1
• Phone enquiry, go to Step 4

Note: only one of the Notice of Reimbursement or Notice of Judgment or Settlement will display depending on which document type was applied to the claim.

• Select the relevant button to confirm:
• Does the Medicare customer selected match the injured person named in the document?
• Does the claim selected match the details in the documents?
• Select the relevant button to confirm:
• Are the documents received incomplete?, go to Step 5
  Note: this button is turned off if the duplicate correspondence button is selected
• If document type selected is Notice of Judgment or settlement and the Incomplete document selection is chosen, an additional button is presented
• Do you want to send refusal letter? Yes, go to Step 7
• Is this duplicate correspondence?, go to Step 6

Note: if an escalation to APS5 or Program Management is needed, Service Officers will need to re-open the claim before escalating, go to Step 8

Is an update to existing contact details required? go to Step 8

Select the relevant button to confirm:

• Have you authenticated the caller and selected the relevant claim?
• Is an update to existing contact details required?
• No, leave button turned off
• Yes, select button to turn on
• Select from the dropdown menu who initiated the update to a closed claim:
• Customer, or
• Service Officer
• A message displays Update contact details. Are you sure you want to update the details of this claim?
• If the claim does not need to be reopened, select No to return to the Evaluate screen. Turn the Is an update to existing contact details required? button off and select Complete
• To reopen the claim, select Yes. go to Step 8

• Select from the dropdown menu who initiated the update to a closed claim:
• Customer, or
• Service Officer
• Select Continue
• A message displays Are you sure you want to send correspondence and close enquiry?
• Select Yes
• Select the form that we are unable to process. Select Notice of judgment or settlement only. Service Officers must confirm the document is for the closed claim. See Claim Management - Medicare Compensation Recovery if details do not match the claim
• To issue a We are unable to process letter, see Process Correspondence - Medicare Compensation Recovery

Procedure ends here.

• Select from the dropdown menu who initiated the update to a closed claim:
• Customer, or
• Service Officer
• Add a case note
• Select Duplicate
• A message advises Did you add a case note?
• Select Yes

Procedure ends here.

• Select from the dropdown menu who initiated the update to a closed claim
• Customer, or
• Service Officer
• Select Continue
• A message advises Are you sure you want to send refusal letter & close enquiry?
• Select Yes
• For a notice of refusal, see Extensions, decisions and reviews - Medicare Compensation Recovery

Procedure ends here.

• Select from the dropdown menu who initiated the update to a closed claim:
• Customer, or
• Service Officer
• Select Continue
• A message displays Update contact details. Are you sure you want to update the details of this claim?
• To reopen the claim, select Yes
• Update contact details of relevant party (only address, phone number or email address to be updated)
• Continue through each screen once updated
• Review updates, select Submit
• Are you sure you want to update claim? Select Yes

Case is resolved-completed, and claim is closed

When in an active case:

• Select Actions from the case summary panel on the left
• Select Terminate WIN from the Actions dropdown menu

Note: if not currently in an active case, create a new Enquiry by selecting the plus icon on the left of the screen, select Enquiry from the Create menu. Select Continue to proceed to the Check existing compensation screen. Enter WIN in Claim details and select Continue. On the Evaluate screen, select Other-all other documents from the Choose document type dropdown menu. Follow the actions described above.

Select the Close reason from the dropdown menu:

• Not proceeding
• Incorrect injured person
• NOPB paid
• Case inactive
• Other
• Small amount <=$5000-
• Closed on combined claims
• Settled in favour of defendant (notifiable person)
• Not notifiable
• Incorrect document linked

Check SAP for payments that may relate to this claim.

Did the agency get any payments for the claim?

• Yes, issue a refund of the payment:
• see Payments, refunds and debts for details about issuing a refund
• go to Step 4
  Note: if the reason for terminating the claim is due to closing a combined claim, the funds may not be required to be refunded and an allocation change will be required to the correct WIN
• No, go to Step 4

• Is the termination reason one of the following?
• Small amount <=$5000
• Settled in favour of defendant, or
• Not notifiable
• Yes, go to Step 6
• No, go to Step 5

• Add a case note to document actions taken on claim
• Select Submit
• Message displays Are you sure you want to close the case?
• Select Yes

Procedure ends here

Does the injured person have a Medicare number?

• Yes, select Claim type > Compensation claim from the dropdown menu, select:
• the relevant recipient
• the preview hyperlink to view the letter
• Submit
• No, select Claim type > Compensation claim cannot be registered from the dropdown menu, select:
• the relevant recipient
• the preview hyperlink to view the letter
• Submit

Create a new Enquiry:

• Select the plus icon on the left of the screen, select Enquiry from the Create menu
• Select Continue to proceed to the Check existing compensation screen
• If the work item number (WIN) is not known, enter the Medicare card number or name in Injured person details screen:
• Check claim details using the WIN hyperlinks
• Select button beside the correct WIN, select Continue

Or

• Enter WIN in Claim details, select Search
• Select the button beside the WIN
• Select Continue

Select document type Other - all other document or Phone Enquiry from the dropdown menu, for:

• Other - all other document, go to Step 4
• Phone enquiry, go to Step 3

Note: if a claim has been terminated, it cannot be reopened.

Select the relevant button to confirm

• Once the Does the Medicare customer selected match the injured person named in the document? button is turned on
• Does the claim selected match the details in the documents? button presents
• Yes, proceed to next buttons
• No, return to Check existing compensation screen. Return to Step 1
• Select the relevant button to confirm:
• Are the documents received incomplete?, go to Step 5
• Is this duplicate correspondence?, go to Step 6
• Is update to existing details required? Selecting this option will turn off both of the previous buttons, go to Step 7

• Select the button to confirm:
• Have you authenticated the caller and selected the relevant claim?
• Is an update to existing contact details required?
• Select from the dropdown menu who initiated the update to a closed claim
• To update a claim, see Claim Management - Medicare Compensation Recovery

Procedure ends here.

• Select from the dropdown menu who initiated update to a closed claim:
• Customer, or
• Service Officer
• Select Continue
• A message displays Are you sure you want to send correspondence and close Enquiry?
• Select Yes
• Select the form that is unable to be processed. Service Officers must confirm the document is for the closed claim
• See Claim Management - Medicare Compensation Recovery if details do not match the claim.
• To issue a 'We are unable to process' (Z2802) letter, see Table 8 on Process page in Process Correspondence - Medicare Compensation Recovery

Procedure ends here.

• Select from the dropdown menu who initiated update to a closed claim:
• Customer, or
• Service Officer
• Add a case note
• Select Duplicate
• A message displays Did you add a case note?
• Select Yes

Procedure ends here.

• Select from the dropdown menu who initiated the update to a closed claim
• Customer, or
• Service Officer
• Select Continue
• A message displays, Update contact details. Are you sure you want to update the details of this claim?
• To reopen the claim, select Yes
• Update contact details of relevant party (only address, phone number or email address to be updated)
• Continue through each screen once details updated
• Review updates, select Submit
• Are you sure you want to update claim? Select Yes
• Case is resolved-completed and claim status is terminated