Notice of judgment or settlement (NOJS) - Medicare Compensation Recovery 011-15040100

• Select Notice of Judgment or Settlement as the document type from the document type dropdown menu
• Select the relevant buttons
• Select continue

Note: if the claim needs updating, for example, after selecting the Is update to existing details required? and then Continue buttons, the claim will flow to the update process before the NOJS can be processed. See Table 4 in Claim management - Medicare Compensation Recovery

• A message displays stating Are you sure you want to process a Notice of Judgment or Settlement? Would you like to continue?
• Select Yes

• Enter the date document received
• If applicable, enter the Date the notifiable person advised the injured person of potential debt liability (S22)
• Select the relevant option from the Was compensation fixed by dropdown menu
• In the Date of judgment or settlement field, enter the date of judgment or settlement
• If applicable, select Is there a date the NP is required to pay the compensation and enter the date into the field generated
• Enter the Total amount of compensation
• If applicable, select:
• Was the compensation based on apportioned liability?
  Enter apportionment percentage into the field generated
• Does the amount of compensation fixed redeem liability for periodic payments? Were past expenses fixed under judgment, Yes, go to Step 5
• Is any amount payable to Centrelink?
  Enter the amount into the field generated
• Has the notifiable person indicated Advance payment intent?
  Enter the amount into the field generated
• Has the notifiable person advised the injured person in writing of AP?
• Does the notifiable person authorise payment of any excess amounts from failed advance payment to the injured person?
• Select Continue
• If none apply, go to Step 9

For more details about:

• Date the notifiable person advised the injured person of potential debt liability (S22), go to Step 4
• Do past expenses awarded represent the Medicare recovery amount / Enter Amount of past medical expenses awarded, select Judgment in the Was compensation fixed by field and go to Step 5
• Is any amount payable to Centrelink, go to Step 6
• Has the notifiable person indicated Advance payment (AP) intent, go to Step 7
• Has the notifiable person advised the injured person in writing of AP, go to Step 8

Note: based on buttons selected additional fields may appear. If none apply, got to Step 9.

• This information is not compulsory
• Notifiable person(s) are not required to provide supporting documents unless they choose to
• If provided, add the date to the field in MCRS
• If the question is not answered, leave blank
• Go to Step 9

If past expenses were fixed, select Were past expenses fixed under judgment?

Do the amounts represent the Medicare recovery amount?

Yes, select Do past expenses awarded represent the Medicare recovery amount?

No,

• do not select Do past expenses awarded represent the Medicare recovery amount?. If this button is selected, the following additional option will present:
• Enter Amount of past medical expenses awarded and/or Amount of past care expenses awarded - one must be entered if either or both past expenses button is selected
• staff must record the amount listed on the NOJS in Amount of past medical expenses awarded and/or Amount of past care expenses awarded
• only complete the relevant field as specified in the NOJS or accompanying documents
• if only one field contains an amount fixed under judgment or settlement, or the Do past expenses awarded represent the Medicare recovery amount is not selected, MCRS will issue a Notice to claimant (NTC)

Go to Step 9.

This information is not compulsory.

If the question is answered on the NOJS enter the amount in the relevant MCRS field. If the question is not completed leave the field blank.

Go to Step 7.

The agency accepts the notifiable person’s intent to make an advance payment (AP) if:

• Do you intend to make an advance payment?, Question on the NOJS is answered Yes
• an Amount of payment equal to 10% of the total amount of compensation is recorded on the NOJS under the intent question
• an Amount of payment equal to 10% of the total amount of compensation has been received in SAP
• attached documents (such as the deed of release) have evidence of the intention to make an AP

Go to Step 9.

This question on the NOJS must be completed, or the attached documentation must show the injured person was advised of the intention to make an AP before settlement.

If this question is not answered, or is answered No, the AP fails. Make sure the field in MCRS is selected, or not selected in accordance with the form/documentation.

Go to Step 9.

MCRS displays the most recent Notice of past benefits.

Has the date of injury changed on the NOJS?

• Yes, go to Table 3
• No, proceed

If a Medicare Compensation Recovery Section 23A statement (MO023) form is received:

• select Has a S23A Statement been provided?
• if the MO023 is complete, select Is S23A complete?
• if accepting the MO023, select Do you accept the S23A?

Note: if the MO023 is received but is incomplete or not accepted leave the buttons turned off beside these two questions. If there is no valid Notice of past benefits (NOPB), a Notice to claimant (NTC) is issued if a current one has not already been issued.

See Process Correspondence – Medicare Compensation Recovery.

Merlin payment details display will present if funds have been received and allocated to the WIN in SAP.

Check for payments in SAP. If the money found in SAP does not match the amount of money displayed in the Merlin File, see Table 5.

If money has been received that relates to the claim, even if not yet allocated to the WIN, select Has any amount been received for this claim in SAP?

• If payment meets the advance payment (AP) criteria select Do payment, document and claim details meet AP criteria?
• Enter Advance payment amount
• Enter Advance payment SAP document # (receipt #)
• Enter the Date advance payment received (Doc date)
• Enter the Compensation payer SAP unique account number (9000####)
• If payment is not an intended AP or does not meet the AP criteria do not select Do payment, document and claim details meet AP criteria?
• Enter Ad-hoc payment amount
• Enter Ad-hoc payment SAP document # (receipt #)
• Enter the Ad-hoc payment date
• Enter the Compensation payer SAP unique account number
• Select Continue

Note: depending on whether the button is selected or unselected, the fields will display as ad-hoc or AP.

If no money has been received:

• Enter the Compensation payer SAP unique account number
• Select Continue

• Review the data entered
• Select Edit to change any details if required
• Select Reprocess SBC if available and if required - Capture SBC displays. See Statement by claimant (SBC) and care costs - Medicare Compensation Recovery.
  Note: use this function if an amendment pre or post claim finalisation requires processing
• Select Submit

The next workflow will change depending on the fields entered in previous steps. A message displays advising what action is required, for an:

• Issue a Notice to claimant (NTC), see Notice of past benefits request and notice to claimant. Procedure ends here
• Issue a Notice of charge (NOC) (where a valid NOPB exists, claim settled by judgment and Medicare recovery set by past expenses awarded, or a S23A is accepted), go to Step 12
• Issue 'Advance payment criteria not satisfied' (Z2810) letter where an advance (AP) has failed, go to Step 13
• Issue 'Compensation payer has not complied with legislated notice requirements' (Z2809) letter where a Notice of judgment or settlement has failed, go to Step 14
• Issue 'Past benefits subsidies will not be recovered' (Z2812) letter if the claim is a S33K, go to Step 16
• Issue a 'Past benefits subsidies will not be recovered' (Z2812) letter if the claim is a S24(4), go to Step 17

If a valid NOPB exists or Statement by claimant (SBC) processed to issue a Notice of charge (NOC):

• Message displays - 'Notice of charge. Case settled by judgment and fixed past expenses awarded, thus issue NOC'
• Select Yes to proceed to NOC summary, see Table 2

If the claim has settled via judgment and Medicare recovery set by past expenses awarded:

• Message displays Case settled by judgment and fixed costs awarded. Close claim on fixed costs NOC
• Select Yes, to proceed to NOC summary, go to Table 2
• If the claim is an advance payment (AP) and the Merlin file does not match the AP amount, the claim needs action by Compensation finance. Go to Table 4, Step 1

If a 'Section 23A statement' (MO023) form is accepted on a claim without a previous NOPB:

• Message displays NOPB not issued and S23A accepted, thus issue the NOC
• Select Yes,
• to proceed to NOC summary, go to Table 2
• if the claim is an AP and the Merlin file does not match the AP amount the claim needs action by Compensation finance. Go to Table 4, Step 1

If an S23A statement form (MO023) is accepted on a claim with an expired NOPB:

• Message displays Expired NOPB extended by S23A. NOPB becomes NOC
• Select Yes to go to the NOC summary, go to Table 2

If the claim is an AP and the Merlin file does not match the AP amount, the claim needs to be completed by Compensation finance, go to Table 4, Step 1

• Message displays [Issue 2810] This claim is a failed AP. (additional messages may display depending on the circumstances of the claim)
• Select Yes

Claims with:

• a valid Notice of past benefits (NOPB) go to the Notice of change (NOC) summary, go to Table 3
• no valid NOPB:
• see Notice of past benefits request and Notice to claimant (NTC) - Medicare Compensation Recovery to issue a new NTC, or
• go to Step 15, to process a returned Statement by claimant (SBC)

Note: 'Advance payment criteria not satisfied' (Z2810) letter is sent to the notifiable person to notify them of the failed AP with a copy sent to the claimant.

• Message displays [Issue Z2809] Notifiable person has failed to comply. S29(3) applies. (additional messages may display depending on the circumstances of the claim)
• Select Yes

Claims with:

• a valid Notice of past benefits (NOPB) go to the Notice of charge (NOC) summary, go to Table 2
• no valid NOPB go to the Notice to claimant (NTC) work step, see Notice of past benefits request and Notice to claimant (NTC) - Medicare Compensation Recovery. Procedure ends here

Note: 'Compensation payer has not complied with legislated notice requirements' (Z2809) letter is sent to the notifiable person to notify them that S29(3) applies with a copy sent with the 'Compensation claim document enclosed' (Z2803) letter to the claimant.

If MCRS determines there is an open SBC work item to process, a pop-up message displays after Submit on the Review screen. This will direct the workflow to the SBC Capture screen.

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

• Message displays S33K applies, thus issue NOC
• Select Yes
• If the Merlin file matches the total amount of payment, the claim automatically reconciles with finance
• If the Merlin file does not match the advance payment (AP) amount, the claim needs action by Compensation finance. See Table 2, Step 1
  Note: 'Past benefits and subsidies will not be recovered' (Z2812) notice is sent to the claimant

See Notice of past benefits (NOPB) and Notice of charge (NOC) - Medicare Compensation Recovery for information on legislative time frames

Note: if funds are to be refunded via EFT, complete the EFT to Finance (valid advance payments) SharePoint form. If EFT details are not held on the claim, no action is necessary. The system prompts the issue of a cheque to the claimant to the address held on the claim. The Resources page has a link to the form.

• Message displays S24(4) applies, thus issue NOC. See Notice of past benefits (NOPB) and Notice of charge (NOC) - Medicare Compensation Recovery
• Select Yes

MCRS does not automate any refund from ad-hoc payments. To organise those refunds by either cheque or EFT complete the Referring a case to compensation finance email template

See:

• Payments, refunds and debts - Medicare Compensation Recovery for further information
• Notice of past benefits (NOPB) and Notice of charge (NOC) - Medicare Compensation Recovery for information on legislative time frames

Note: 'Past benefits and subsidies will not be recovered' Z2812 letter is sent to the claimant.

A table displays with the NOC summary.

Review the summary and totals displayed:

• Select Cancel, if the totals are incorrect
• Select Submit, if the totals are correct
• Go to Step 2 if the amount payable/refundable does not exceed the threshold
• If the amount payable/refundable exceeds the threshold, the Review and approve ‘To do’ screen will appear, do not select Go. Select Home from the left-hand side menu, see Table 3 for details about NOC approval - changes required.

The correspondence to be issued will vary depending on information previously entered.

• Select the Notification type from the dropdown menu
• Select the relevant letter recipient
• Select the Preview hyperlink to view the letter
• Add a case note to detail action taken
• Select Submit

Refund from valid advance payment (AP)

If funds are to be refunded via EFT, complete the EFT to Finance (valid advance payments) SharePoint form. If EFT details are not held on the claim, no action is necessary. The system prompts the issue of a cheque to the claimant to the address held on the claim.

Refund from failed AP

Complete the Referring a claim to Compensation Finance email template, providing EFT details if supplied. If EFT details are not held on the claim, a cheque will be issued. Make certain that correct address details are provided on template for payee.

Where MCR recognises:

• a Most Recent/Previous Notice of past benefits (NOPB) exists
• the From Date of the most recent or previous NOPB is not the same as DOI, and
• NOJS details are captured by a Service Officer

The button Do you want to close case on last NOPB? (default deselected) will be displayed. Dependant on case detail existing for the claim, the Service Officer may/may-not choose this option and continue to the NOJS Review step.

If button is:

• selected, go to Step 3
• not selected, go to Step 4

If the button is selected the mismatch between the updated DOI and the start date of the NOPB will be disregarded, and the NOPB considered in subsequent processing. This will not override the expired status of the NOPB or the DOJS being outside its span.

At the:

• NOJS Capture Assess step: an information message will be displayed beneath the selected button The relevant NOPB will be used to close the claim, and
• Submit to NOJS Review step: any relevant NOPB will be considered for Notice of charge (NOC) assessment and issuance. For example, selecting the button will not alter the expired status of the NOPB and would only close the claim if S23A form was also accepted. Similarly, if the DOJS is outside of the span of the NOPB then in addition to selecting the button the Reprocess SBC button in Review NOJS will also need to be selected

If open MCRS claim

At Submit to NOJS Review step, any mismatched NOPB will not be considered by MCRS for NOC assessment and issuance.

If re-opened MCRS/Legacy claim

At Submit to NOJS Review step:

• The system will not proceed to NOC/NOPB-AP summary step where there is no amount available to populate the NOC (Issue Notice to claimant (NTC) is not allowed on re-opened claims) and instead will display a Pop-up message No values created for NOC. Select Close case on last NOPB to continue processing
• Select OK button

On selection of OK button:

• The work item will remain at the NOJS Review step
• The Service Officer has an opportunity to review, and if necessary, amend NOJS Capture Assess details/Re-process SBC

The NOC summary screen presents with the history of the review process including Reviewer comments. Are changes needed?

• Yes,
• select Actions from left hand menu
• select Return to capture details from Actions dropdown menu
• No, see Medicare Compensation Recovery quality checking

• Select Submit from Return to capture details
• Select Yes from Return to capture message that presents
• Correct as required:
• NOJS
• Assess
• Capture SBC to produce corrected NOC Summary
• Select Submit

Once corrected, the work item is sent to quality checking for approval

When the Merlin file does not match the AP details (+/- $1), the claim is marked as complex and action by Compensation Finance is needed. See Payments, refunds and debts - Medicare Compensation Recovery.

Select the relevant radio button and select OK:

• Combine Payment - AP is valid but payment in SAP is split, go to Step 2
• Move NOPB funds back - previous NOPB amount paid, and AP amount paid. NOPB payment moved to Medicare card to allow refund to be processed, go to Step 3
• Make correction in SAP - AP found in SAP and not yet allocated to the claim, go to Step 4

Combine payment must not be requested before all allocation changes have been actioned and are visible in Merlin. See Payments, refunds and debts - Medicare Compensation Recovery.

• An email template within MCRS displays
• Complete the required fields
• Add a case note to detail action taken
• Select Send email
• Select Submit, confirm Yes for case note added
• MCRS will put the claim on hold for 24 hours
• Procedure ends here

Note: when work item is received back from Finance and the combine payment has been completed, the receiving Service Officer must finalise the claim and action refunds as per below. A Finance case note would have been entered to show Finance action completed.

Refund from valid AP

If funds are to be refunded via EFT, complete the EFT to Finance (valid advance payments) SharePoint form. If EFT details are not held on the claim, no action is necessary. The system prompts the issue of a cheque to the claimant to the address held on the claim.

Move NOPB funds back must not be requested before all allocation changes have been actioned and are visible in Merlin. See Payments, refunds and debts - Medicare Compensation Recovery.

• Message displays Submit request to move NOPB funds back using SharePoint link
• Select the hyperlink
• Complete the Allocation change SharePoint form, select Submit on the template
• Add a case note to detail action taken
• Select Submit, confirm Yes for case note added
• MCRS will place the claim on hold for 24 hours
• Procedure ends here

Note: When work item is received back from Finance and allocation change has been completed, the receiving Service Officer must finalise the refunds as per below and close the claim as per Table 1, Step 10. A Finance case note would have been entered to show Finance action completed.

Refund from valid AP

If funds are to be refunded via EFT, complete the EFT to Finance (valid advance payments) SharePoint form. If EFT details are not held on the claim, no action is necessary. The system prompts the issue of a cheque to the claimant to the address held on the claim.

The Resources page has a link to the SharePoint form.

• Message displays Submit request to make correction in SAP using SharePoint link
• Select the hyperlink
• Complete the Allocation change SharePoint form
• Add a case note to detail action taken
• Select Submit, confirm Yes for case note added
• MCRS will place the claim on hold for 24 hours
• Procedure ends here

Note: when work item is received back from Finance and allocation change has been completed, the receiving Service Officer must finalise the refunds as per below and close the claim as per Table 1, Step 10. A Finance case note will have been entered to show Finance action completed.

Refund from valid AP

If funds are to be refunded via EFT, complete the EFT to Finance (valid advance payments) SharePoint form. If EFT details are not held on the claim, no action is necessary. The system prompts the issue of a cheque to the claimant to the address held on the claim.

The Resources page has a link to the SharePoint form.

The NOC summary screen presents with the history of the review process including reviewer comments. Are changes required?

• Yes,
• select Actions from left hand menu
• select Return to capture details from Actions dropdown menu
• No, go to Table 2

• Re-open claim by selecting NOJS or Notice of Reimbursement Arrangement (NORA) from the Doc type on the Evaluate screen
• See Table 1 in Close, terminate, update or reopen a claim - Medicare Compensation Recovery

• Select the button for Centrelink Payment: Is any amount payable to Centrelink?
• Enter the amount and select Continue

• Confirm payment details in SAP are entered into MCRS.
• Select Continue

Once you are satisfied with the information displayed on the Review screen, select Submit to produce the NOC summary screen and issue the amended NOC.

Complete the Referring a case to compensation finance email template informing them that the NOC has been amended due to Centrelink recovery and the debt and or refund are not accurate.

See Resources page.