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
• if any details on the claim need updating, select:
• Is update to existing details required?
• Continue, 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
• Enter the Total amount of compensation
• If applicable, select:
• Was the compensation based on apportioned liability?
  Enter apportionment percentage
• Does the amount of compensation fixed redeem liability for periodic payments?
• Were past expenses fixed under judgment?
• Is any amount payable to Centrelink?
  Enter the amount
• Has the notifiable person indicated Advance payment intent?
  Enter the amount
• Has the notifiable person advised the injured person in writing of AP intent?
• Does the notifiable person authorise payment of any excess amounts from failed advance payment to the injured person?
• If none apply, select Continue. 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
• advised the injured person in writing of AP intent, go to Step 8

It is not compulsory for the notifiable person to provide supporting documents, however if they:

• provide documents, add the date in MCRS
• do not answer the question, leave blank
• Select Continue
• Go to Step 9

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

MCRS issues a Notice to claimant (NTC) when:

• 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

Do the amounts represent the Medicare recovery amount?

• Yes:
• select Do past expenses awarded represent the Medicare recovery amount?
• key the Amount of past medical expenses awarded and/or Amount of past care expenses awarded. If Were past expenses fixed under judgment? is selected, at least one of these fields must contain an amount
• only complete the relevant fields specified in the NOJS or accompanying documents. For example, leave the field blank if there is no amount. Do not enter zero as this will impact the outcome
• Select Continue
• Go to Step 9
• No:
• do not select Do past expenses awarded represent the Medicare recovery amount?
• Select Continue
• Go to Step 9

These details are not compulsory.

If the question is:

• answered on the NOJS
• select the button
• key the amount in the relevant MCRS field
• not completed, do not select the button

Select, Continue and 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
• Select, Continue and go to Step 8

This question on the NOJS:

• must be completed, or
• has documentation that shows the injured person was advised of the intention to make an AP before settlement
• will cause the AP to fail if it is answered 'No' or is not answered. Make sure the MCRS details match the form/documentation
• Select, Continue, and go to Step 9

MCRS displays the most recent Notice of past benefits.

If the date of injury on the NOJS has changed see Table 3.

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?
• if the MO023 is incomplete, or not accepted deselect both the following questions:
• Is S23A complete?
• Do you accept the S23A?
• MCRS issues a Notice to claimant (NTC) when:
• there is no valid Notice of past benefits (NOPB), and
• a current one has not already issued

See:

• Medicare Compensation Recovery Section 23A statement form (MO023)
• Document Assessment – 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 (Doc date)
• Enter the Compensation payer SAP unique account number (9000####)
• 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 (9000####)
• Select Continue

• Review the data entered
• Select Edit to change any details if required
• Select Reprocess SBC if available and if required. Select Continue. The Capture SBC screen shows. See Statement by claimant (SBC) and care costs - Medicare Compensation Recovery. Use this function if an:
• amendment pre or post claim finalisation requires processing, or
• NOPB was issued after the DOJS
• 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) when a valid NOPB exists, claim settled by judgment and Medicare recovery set by past expenses awarded, go to Step 12
• Issue a Notice of charge (NOC) when the:
• S23A is accepted, go to Step 13
• NTC already issued and SBC pending capture, go to Step 16
• Issue 'Advance payment criteria not satisfied' (Z2810) letter where an advance (AP) has failed, go to Step 14
• Issue 'Compensation payer has not complied with legislated notice requirements' (Z2809) letter where a Notice of judgment or settlement has failed, go to Step 15
• Issue 'Past benefits subsidies will not be recovered' (Z2812) letter if the claim is a S33K, go to Step 17
• Issue a 'Past benefits subsidies will not be recovered' (Z2812) letter if the claim is a S24(4), go to Step 18

If:

• the pop up ‘Wait for advance payment’ shows, the NOJS details were captured within 28 days from the date of judgment or settlement. Select OK, the system holds the claim for the 28 day period to allow for receipt of the AP payment.
• it is 28 days after claim processing and funds have not been received:
• Enter the Compensation payer SAP unique account number (9000####)
• Select continue

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, see 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. See Table 5 > 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, see 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. See 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, see 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, see Table 4 > Step 1

• Message displays [Issue Z2810] This claim is a failed AP. (additional messages may display depending on the circumstances of the claim)
• Select Yes

For claims with:

• a valid Notice of past benefits (NOPB) go to the Notice of charge (NOC) summary, see Table 3
• no valid NOPB:
• to issue a new NTC, see Notice of past benefits request and Notice to claimant (NTC) - Medicare Compensation Recovery, or
• to process a returned Statement by claimant (SBC), go to Step 16

To notify that the AP has failed, send the following letters to the:

• notifiable person - 'Advance payment criteria not satisfied' (Z2810)
• claimant - 'Compensation claim document enclosed' (Z2803) letter with a copy of the 'Advance payment criteria not satisfied' (Z2810)

If the [Issue Z2809] Notifiable person has failed to comply. S29(3) applies, shows, select Yes.

Additional messages may display depending on the circumstances of the claim.

For claims with:

• a valid Notice of past benefits (NOPB), go to the Notice of charge (NOC) summary, see 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

Send the following letters to the:

• notifiable person - 'Compensation payer has not complied with legislated notice requirements' (Z2809)
• claimant - 'Compensation claim document enclosed' (Z2803) letter with a copy of the 'Compensation payer has not complied with legislated notice requirements' (Z2809)

If MCRS has an open SBC work item to process:

• after Submit on the Review screen a pop-up message Resume SBC capture shows
• Select Yes. The SBC Capture screen shows

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

Once SBC is processed from the Capture S23A and payment details screen:

• Confirm SAP details
• Select Is S23A and Advance Payment details verified?
• Select Submit
• See Table 2

• 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:
• Send the 'Past benefits and subsidies will not be recovered' (Z2812) notice to the injured person or claimant
• the claim needs action by Compensation finance, see Table 5

See:

• Notice of past benefits (NOPB) and Notice of charge (NOC) - Medicare Compensation Recovery for details about legislative time frames
• Payments, refunds and debts - Medicare Compensation Recovery for details about actioning a refund

• Message displays S24(4) applies, thus issue NOC. See Notice of past benefits (NOPB) and Notice of charge (NOC) - Medicare Compensation Recovery
• Select Yes
• Send the following letters to:
• notifiable person - 'Past benefits and subsidies will not be recovered' (Z2812)
• claimant - 'Compensation claim document enclosed' (Z2803) letter with a copy of the 'Past benefits and subsidies will not be recovered' (Z2812)

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

See:

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

A table displays with the NOC summary.

Review the summary and totals displayed:

• Totals are incorrect:
• select Back
• check and correct if needed
• add a case note and include details of all actions taken
• Totals are correct, select Submit
• For an amount payable/refundable that does not exceed the threshold, if the:
• Thank you! The next step in this case has been routed appropriately message shows, select Exit work item from the left panel. Procedure ends here
• Issue correspondence screen shows, go to Step 2
• For an amount payable/refundable that exceeds the threshold:
• the Review and approve ‘To do’ screen shows
• do not select Go
• select Exit work item from the left panel, see Table 4 for details about NOC approval - changes required

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

To issue correspondence:

• Select the Notification type from the dropdown menu
• Select the relevant letter recipient
• Select the Preview hyperlink to view the letter
• Select Submit

For all refunds see Payments, refunds and debts - Medicare Compensation Recovery.

For any changes to the DOI on a claim, update the:

• claim to issue a new Notice to claimant, or
• liability period to show the updated information

Where a notice has been issued, re-process the claim to show the correct liability period.

In limited circumstances an existing Notice of past benefits (NOPB) can be used to close the claim. Tables 1 - 3 on Resources page contain more details. For assistance, see Escalations - Medicare Compensation Recovery

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 show. 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 4
• not selected, go to Step 5

At Submit to NOJS Review step for:

• open MCRS claim, any mismatched NOPB will not be considered by MCRS for NOC assessment and issuance
• re-opened MCRS/Legacy claim:
• where there is no amount available to populate the NOC, the system will not go to the NOC/NOPB-AP summary step. The Pop-up message No values created for NOC shows
• Select, Close case on last NOPB
• Select, OK. The work item is at the NOJS Review step

The Service Officer can:

• review the NOJS
• amend NOJS Capture Asse/Re-process SBC

Where the M-case is invalidated or resolved-dependant, further action is needed for MCRS to recognise an issued NTC/NOPB. See Statement by claimant (SBC) and care costs - Medicare Compensation Recovery.

When the Close case on Last NOPB is selected the:

• mismatch between the updated DOI and the start date of the NOPB will be disregarded, and
• NOPB is considered in subsequent processing
• system will not override the expired status of the NOPB or a DOJS that is outside the span of the NOPB

At the following steps:

• NOJS Capture Assess:
• an information message is displayed beneath the selected button
• The relevant NOPB will be used to close the claim
• Submit to NOJS Review:
• 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
• if the DOJS is outside of the span of the NOPB, at Review NOJS, select Reprocess 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 assurance

Complete the following:

• 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. l

Advance Payment (AP) is valid

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. For:

• Combine Payment - AP is valid with payments in SAP split over multiple payments from:
• the same notifiable person, go to Step 2
• different notifiable persons, do not use Combine Payment, escalate to Program Management, see Escalations - Medicare Compensation Recovery
• Move Notice of past benefits (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

Advance payment is not valid

MCRS does not have the ability to combine payments on a non-AP claim.

Where there are multiple payments that match the intended AP or NOPB amounts staff must send Finance a Referring a claim to Compensation finance email, the Resources page contains the link.

To include details of all payments, copy and paste the Payment details section from the template for each payment received. See Payments, refunds and debts - Medicare Compensation Recovery.

On the Assess NOJS details screen complete the following:

• Ad-hoc payment amount field, key total payment amount
• Ad-hoc payment SAP document# (receipt#) field, key the document numbers for all later payments
• Ad-hoc payment date field, key the date received for all later payments
• Compensation payer SAP unique account number for the main compensation payer

Procedure ends here

Before requesting a Combine payment, all allocation changes must be actioned and clearly visible in Merlin. See Payments, refunds and debts - Medicare Compensation Recovery.

To request a Combine payment:

• the email template within MCRS shows, complete all required fields
• add a case note detailing all actions taken
• select Send email
• select Submit, confirm Yes for case note added
• MCRS puts the claim on hold for 24 hours

When the combine payment is complete the work item is returned from Finance with a case note showing all actions taken. The receiving Service Officer must finalise the claim and action any refunds. Payments, refunds and debts - Medicare Compensation Recovery.

Procedure ends here.

Before requesting a Move NOPB funds back, all allocation changes must be actioned and clearly 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

When the allocation change is complete the work item is returned from Finance with a case note showing all actions taken. The receiving Service Officer must finalise the claim, action any refunds and close the claim see Table 1 > Step 10.

To process refund, see Payments, refunds and debts - Medicare Compensation Recovery.

Procedure ends here.

To make a correction in SAP:

• 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

When the correction in SAP is complete the work item is returned from Finance with a case note showing all actions taken. The receiving Service Officer must finalise the claim, action any refunds and close the claim see Table 1 > Step 10, and Payments, refunds and debts - Medicare Compensation Recovery.

Procedure ends here.

Claims that reach judgment or settlement for less than or equal to $5,000.00:

• are not notifiable, and
• must be terminated. See Table 3 in Close, terminate or reopen a claim - Medicare Compensation Recovery

See: Notifiable and not notifiable claims - Medicare Compensation Recovery.

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

• Select Centrelink Payment: Is any amount payable to Centrelink? An additional field will show
• Enter the amount and select Continue

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

When the details are showing correctly on the Review screen:

• select Submit to produce the NOC summary screen, and
• issue the amended NOC

Does the Centrelink recovery amount impact Medicare Compensation recovery?

• Yes, go to step 5
• No, select Submit to close claim

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.

On the Claim Details tab:

• Review the following sections:
• Pre-settlement, and
• Judgment/Settlement
• In the Pre settlement section confirm:
• Notice to claimant (NTC) is recorded as issued, see Date NTC sent, and
• SBC is not recorded as received after that date, see Date SBC received
• where details are recorded in the Judgment/Settlement section and no J-case is available a new J-case must be created

To process the SBC, MCRS must recognise the previously issued NTC.

Complete the following:

• create a new enquiry case using the WIN
• on the Evaluate screen, select Notice of past benefits request from the Document type menu
• Select Does the claim selected match the details in the documents?
• Select Continue

To capture the NTC:

• Select Process the SBC for last NTC and issue a new NOPB. The Capture NTC details will show
• Select Submit. The Are you sure you want to issue a new Notice to Claimant? message shows
• Select yes. The Capture SBC screen shows

Has a NOJS been received?

• Yes:
• Do not process the SBC
• Select Save at the bottom of the screen
• Select Exit work item from the left hand panel
• Go to step 4
• No, See, Statement by claimant (SBC) and care costs - Medicare Compensation Recovery

Do not select recapture NOJS where a new J-case has been created for example, where a previous J-case was invalidated. This is not considered a recapture.

To create a new enquiry case using the WIN:

• Go to the Evaluate screen
• Select Notice of judgment or settlement from the Document type menu
• Select Does the claim selected match the details in the documents?

Is the View Compensation Details screen showing evidence of a partial NOJS capture and not allowing processing of the SBC?

• Yes:
• Select Recapture the NOJS details
• Select Continue
• No, select Continue

MCRS recognises a pending SBC. When the Are you sure you want to process a Notice of judgment or settlement? Existing NTC Case is available for use in the NOJS case. Would you like to continue? message shows:

• Select Yes
• Capture NOJS details. See Table 1, Steps 3 - 11
• Check the review screen shows the correct details
• Select Submit

When the message showing an SBC pending capture is available:

• Select Keep assigned to me
• Select OK
• Process the SBC see Table 1 > Step 16
• Select Submit

Complete the following:

• Select Is S23A and Advance Payment details verified?
• Select Submit
• Review the NOC/NOPB-AP screen to confirm details are correct
• See Table 2