Mail process and Work Optimiser - Medicare Compensation Recovery 011-15070020

Does the information relate to a Medicare Compensation Recovery claim?

• Yes, go to Step 2
• No, go to Step 4

Remove all staples and paper clips and check if documents are single or double sided.

Place all pages for one claim on the scanner feed tray.

On the MFD touch screen:

• Select the Email icon
• Select + Add recipient > Public Entries
• Select the Medicare Compensation Recovery mailbox from the list, then OK.
  The email address is saved on MFDs in Brisbane and Perth. The email address may need to be entered manually at other locations
• Select 1-Sided or 2-Sided Scanning
• Select Send

Note:

• Service Officers must not send emails to MCRS from their personal email address
• If the attachments are about more than one claim:
• Scan to an email as a single package so that FileNet contains a true record of correspondence received by the agency
• Copies will be redacted and saved to a work identification number (WIN) when the correspondence is processed

After scanning, place the received hard copy document into the current archive box for retention ordered by date of receipt.

If unsure, contact a Team Leader for the location of the current archive box.

Procedure ends here.

If the document is for:

• Medicare Compensation Finance team:
• Do not scan the document/s, document examples include, cheques and remittance advices
• Place the document/s in an internal mail envelope
• Send to Compensation Finance Team
• Medicare Public or Medicare General Enquiries:
• Do not scan the document/s
• Place the document/s in an internal mail envelope
• Send to the relevant team or Service Officer
• Centrelink Compensation Program:
• Do not scan the document/s, Document examples include, requests for Centrelink clearance certificates
• Place the document/s in an internal mail envelope
• Send it to the Centrelink Compensation Recovery Team
• Medicare debt recovery team:
• Do not scan the document/s
• Document examples include, requests to set up a payment plan or repay a debt
• Place the document/s in an internal mail envelope
• Send it to Debt Recovery Parramatta, see Medicare Debt Recovery for address

Service Officers unable to identify what to do with a piece of correspondence, must contact Tier 1 support.

Is the document on the claim missing pages?

• Yes, go to Step 2
• No, procedure ends here

Is the received date shown for the document on the Documents tab older than 70 days?

• Yes, contact the party that would have sent the document. For example, Statement by claimant (SBC) - injured person/authorised third party, Notice of judgment or settlement (NOJS) - notifiable person:
• successful contact. Request another copy of the document to be sent or emailed, or
• unsuccessful contact. Issue a We are unable to process (Z2802) letter. See Table 8 on the Process page in Process Correspondence - Medicare Compensation Recovery
• Procedure ends here
• No,
• request a rescan. See Table 3 on the Process page in Manage Medicare scanning
• Procedure ends here

Note: add a case note on the claim detailing every contact attempt

Open the MCRS Rejections mailbox.
Note: mailbox access is requested through ISP.

A copy of each failed email and attachments is sent to this mailbox as an .eml attachment to a message titled 'Unable to import email from <sender’s email address>'. The body of the email advises - ‘The attached email was unable to be imported. Manual intervention will be required'.

Check if any of the following applies

Go to Step 2 if:

• the file type (file type is visible as part of the attachment’s file name) is not recognised by Kofax, the file is not a:
• PDF
• JPG
• PNG
• TIF
• TIFF
• BMP
• GIF
• DOC
• DOCX, or
• TXT
• the total file size is more than 5MB (email size is visible in the mailbox)
• there are embedded images and/or URLs, for example:
• photos
• email, or
• web addresses that show the location when the mouse is hovered over the text/image

Go to Step 3 if there:

• is a ‘read receipt’ request (pop up message when the email is opened)
• are links to documents stored in online storage facilities (wording in the email will indicate this) like:
• Dropbox, or
• Google Docs
• are password protected/encrypted attachments or files (attachment cannot be opened and a password is requested) in a:
• WinZip, or
• RAR file

Note: If the:

• correspondence contains a file not intended for Medicare Compensation Recovery - Delete the email
• email is recognised as phishing or spam - Report the email before deleting. See What to do when you receive SPAM or Phishing Emails

Otherwise, go to Step 3

Print to PDF

Print to PDF:

• removes all embedded hyperlinks and flattens the document
• makes the document smaller while keeping the written text, and
• may be enough to reduce the file size to below 5MB

Open the document:

• Select File > Print, then choose printer Adobe PDF or Print to PDF (depending on the application)
• Save the new document temporarily in the shared folder, CompRec > Redaction Working folder
• If a file with the same name is already used, the message This file already exists. Replace existing file? appears. Rename the file with a unique name

Or

Print the email and attachment/s that are the cause of the rejection

Printing the email and attachment/s also removes embedded hyperlinks while keeping the written text. This may not always be enough to reduce the file size to below 5MB.

Open the document:

• Select File > Printer > Print
• Scan the documents to the Medicare Compensation Recovery mailbox. For scanning instructions go to Table 1 > Step 2

Or

Convert to PDF and reduce PDF file size

Use this option if unable to print to PDF or the file remains above 5MB

Open the document:

• Select File > Save As
• Select 'Save as type' PDF (*.pdf). Once processed the new PDF document opens in Adobe Acrobat Pro
• Select File > Save as Other > Optimised PDF
• Select Settings > Custom > Discard Objects (left hand box) > select all boxes
• Select Discard User Data (left hand box) > select all boxes
• Select Clean Up (left hand box) > select all boxes > OK
• Save the reduced file size document to in the shared folder CompRec > Redaction Working folder
• If a file with the same name is already used, the message This file already exists. Replace existing file? appears. Rename the file with a unique name
• Use Adobe to split the document into files that are smaller than 5 MB. Make sure the entire file is captured and no pages are missed

Does the adjusted email and/or attachments meet Kofax requirements?

Yes,

• attach the amended documents and a PDF copy of the original email into a new email
• copy and paste the subject line from the original email into the subject line of the new email and send to the Medicare Compensation Recovery mailbox with an Official classification
• emails must not be sent from personal mailboxes, only send emails from the Medicare Compensation Recovery mailbox:
• in Outlook > select From, then
• Medicare Compensation Recovery mailbox
  Note: if the Medicare Compensation Recovery mailbox is not available when selecting From, select Other E-mail Address and search for the Medicare Compensation Recovery mailbox. Select OK, the Medicare Compensation Recovery mailbox will be added to the list
• procedure ends here

No, go to Step 3

Service Officers must only send emails from the Medicare Compensation Recovery mailbox. Emails must not be sent from personal mailboxes.

See Medicare letters and electronic messaging to access the Compensation Recovery letters and emails page:

• Select the hyperlink Your email or attachments could not be opened (Z2875)
• Select Open. The email template will open

Complete the fields:

• From: Enter the Medicare Compensation Recovery mailbox email address
• To: copy originator’s email address from their email. For example, name@domain.com
• Date Sent and Subject (in email body): add the original sent date and originator’s email subject to the body of the email. The subject of the email to be sent has already been pre-populated

Do not:

• add any other text to the email
• attach any documents, or
• add a personal signature block

Note: a blind carbon copy (Bcc) of the email is sent to the MCRS Rejections mailbox

Service Officers must file the:

• copy of the email in the Rejection templates sent folder
• original email in Kofax re-attempts folder

• Select the green Work Optimiser - Health icon on the desktop to access the dashboard
• Select Worklist to access work items
• Select My Work tab in the upper left hand corner to view work currently assigned:
• If no work items have been assigned, the Work Items screen will be blank
• Complete open items in My Work before requesting a new work item to process

• Select Ready from the bottom right hand corner of the screen to get a work item
• Selecting Ready will open the work item in the Work Item and Customer Details for Work Item ID screen (for example E-XXXX, M-XXXX, J-XXXX etc) which has tabs for:
• Summary
• Details
• Actors
• WLM Attributes
• Work item Attributes
• Actor attributes
• Touchpoints
• Classification history, and
• History
• To go back to the Worklist, select Back
• If a bundled work item presents, go to Step 7

Select Columns in the work items table to display details about the work item:

• Work Item ID is a unique identifier for the work item (one letter and 5 numbers, for example, E-12345)
• Work Type is the name of the work type, for example, Third Party Authority (MO021) or Notice of past benefits (NOPB) (MO026) request
• Work Item Status displays as either:
• Open
• Closed, or
• Completed
• Priority displays the priority value of a work item
• Read is the date work item details were allocated

From the Work Item ID column, select a work item ID:

• Select Work Item Details go to Step 5, or
• Select Open in MCRS, go to Step 6

Selecting Work Item Details displays the following information about the work item:

• Client: the work identification number (WIN) displays, if applicable. A WIN will not be on an E-case if a corresponding one has not been identified by Kofax
• Employee Responsible: the name and logon ID of the Service Officer who has been assigned the work item
• Contact Time Range: unrestricted for MCRS (work type is not time zone sensitive)
• Work type, the name of the work item, for example, Notice of Judgement or Settlement (MCRS DOC ASS MO022)
• WLM Status: Open, Completed, or On Hold
• Allocation Method: Ready - Allocated from inbox
• Number of Touchpoints: number of times this work item has been allocated and/or reassigned
• Priority: decided by Operational Planning Health team
• Requested Start Date/Time: when the work item was created
• Hold Release Start Date/Time: when the work item status updates from Hold to user (HTU) back to OPEN (and is then reassigned if not actioned within 48 hours)

If the work item has bundled cases, go to Step 7

Select Open in MCRS to redirect to MCRS to action the work item.

Note: completed work items cannot be reopened with Work Optimiser - Health. When work items have been completed the claim must be viewed through Restricted Claim Actions.

If the work item has bundled cases, go to Step 7

An additional window will present titled Allocate the following bundle

• Columns show:
• Work Type Description
• Allocate
• Bundle Reason
• User Reason, and
• Work Item ID
• The highest priority document type, for example, Notice of Judgement or Settlement (MCRS_DOC_ASS_MO022 will be allocated as the Parent Work Item
• Select Submit
• Worklist screen will present with the case reference of the parent work item
• Select Open in MCRS button from the top right hand corner of screen
• All documents contained in the case will be presented in the Files & documents tile, each individual case from bundle will need to be viewed and actioned separately

Note: staff that get a bundle containing a work type they are not trained in should direct the work items to an appropriately skilled Service Officer by proficiency raising the work item through Work Optimiser. See Table 6 in Technical support and escalations - Medicare Compensation Recovery

Where MCRS presents multiple unclassified documents, or an unclassified document and another work item in a bundle for a suggested claim. Service Officers must complete the highest priority item first and check all cases to make sure they are taking the correct action.

Are all of the bundled documents related to the same customer/claim?

• Yes, see Table 1 on the Process page in Process Correspondence - Medicare Compensation Recovery to complete document assessment and complete actions on the claim
• No, see Table 5 on the Process page in Process Correspondence - Medicare Compensation Recovery to unlink documents

Options for a work item are available through the Actions bar at the bottom of the Worklist screen:

• Hold to User (HTU): prevents the item from being reassigned. A reminder date/time must be set
• Reassign: transfers the item to another specified user’s work list
• Unassign: move the item back to the pool if it has been incorrectly assigned. An unassign reason must be chosen:
• Capability adjusted: skill tag changed (not trained in that work type)
• Proficiency Raised: for example, from established to experienced
• Recategorised: work type changed, for example from MOO21 (MCRS DOC ASS MO021) to MO026 (MCRS DOC ASS MO026)
• Service Support Referral: n/a - do not use for MCRS
• User Unavailable: for example, on holiday or no longer working in the section

Service Officers can discuss with Tier 1 support or a Team Leader about when to unassign or hold a work item.

A work item will remain on hold until it is completed, reassigned or unassigned. Items not Held to User will remain in the work list for 48 hours before being re-allocated.

See Technical support and escalations - Medicare Compensation Recovery for more information on reassigning and assigning.

To exit Work Optimiser:

• Select the X at the top right hand corner, or
• Select Log off from the dropdown menu

Compensation Finance is the correct destination for all remittance advice.

Has Compensation Finance been included as a recipient of the email (including CC)?

• Yes, go to Step 3
• No, go to Step 2

Note: there may be occasions where the remittance has been specifically requested by a Service Officer. For example, to verify if a payment received is related to a claim. In these instance, go to Step 4.

Make an outbound call to the sender and tell them to direct the remittance advice to Compensation Finance, as per the email provided in the Notice of Judgment or Settlement (MO022) form.

If contact is unsuccessful:

• complete the Action required - Your remittance advice cannot be actioned (Z2916) email template. See Letters and electronic messages on the Resources page for a link to the email template
• send the email from the Medicare Compensation Recovery mailbox to the originator of the email

The details provided in the email template confirms that the sender must re-send the remittance advice to Compensation Finance directly.

Service Officers must only send emails from the Medicare Compensation Recovery mailbox. Emails must not be sent from personal mailboxes:

• From the Operation Blueprint letters and electronic messaging page:
• Select Medicare - Provider and Third Party letters
• Select Medicare - Compensation Recovery
• Open the Compensation Recovery twisty to locate Letters and Emails
• Select the Z2916 hyperlink
• Select Open. The email template will open

Complete the fields:

• From: Select Medicare Compensation Recovery mailbox email address from the dropdown menu
• To: Copy the originator’s email address from their email. For example, name@domain.com
• Date Sent and Subject (in email body): add the original sent date and originator’s email subject to the body of the email. The subject of the email to be sent has already been pre-populated

Do not:

• add any other text to the email
• attach any documents, or
• add personal signature block

Go to Step 3.

Does the remittance correspondence include other Medicare Compensation Recovery documents?

• Yes, go to Step 4
• No, go to Step 6

Do the documents include multiple customer details?

• Yes, to:
• complete the Enquiry case work step which adds the documents to the claim. See Table 1 on the Process page in Claim Management - Medicare Compensation Recovery
• unlink the document. See Table 5 on the Process page in Process Correspondence - Medicare Compensation Recovery
• No, go to Step 5

Take appropriate action to finalise work steps and link the remittance to the claim with the other documents. See Table 1 in Claim Management - Medicare Compensation Recovery.

Procedure ends here.

Select Actions from the left hand panel > Invalid work from the dropdown menu:

• Add appropriate reason
• Select Submit

Procedure ends here.

Unclassified documents can be broken into 4 main categories:

• Incoming mail intended for Medicare Compensation Recovery
• Remittance advice, see Table 5
• Non-actionable correspondence, for example, SPAM emails and read receipts
• Correspondence not intended for Medicare Compensation Recovery, go to Step 3

Any correspondence needing further action must be re-categorised to the most appropriate WLM queue for incoming correspondence work types. For re-categorisation options, see Table 2 on the Resources page.

Examples may include:

• Subpoenas, see Table 6 on the Process page in Authority to access a claim - Medicare Compensation Recovery
• Photograph of a Medicare Compensation Recovery form sent in an email
• Requests for claim updates with no form attached
• RTS - Return to sender correspondence
• Deeds of release

• Documents for other departments/agencies
• Medicare Public rebate enquiries
• Medicare enrolment forms
• Correspondence unable to be matched to a claim or injured person
• Spam emails
• Remittance advice, see Table 5

Is the correspondence intended for Medicare Compensation Recovery?

• Yes, go to Step 4
• No, go to Step 5

Select the Open in MCRS button from Work-Optimiser - Health to open the Enquiry case.

Check the Enquiry case, case notes and relevant documents to determine what actions are required for the claim.

Service Officers must identify the form/work type required to be completed. See Document Assessment - Medicare Compensation Recovery.

Un-assign the work item in Work Optimiser:

• Reason: Re-categorised
• Work Type Program: Medicare Compensation Recovery
• Work Type Process Category: Claims
• Work Type: select as necessary based on the documentation in the enquiry/ required work-step, see Table 2 on the Resources page
• Select Submit

Note: do not re-categorise to Service Officer (SO4) priority queue unless exceptional circumstances exist.

Procedure ends here.

Service Officers must invalidate the enquiry as no action is needed.

• In the MCRS case screen, select the Actions menu in the left top corner of the Enquiry screen
• Select Invalid work
• Enter a reason for invalidating case
• Select Submit
• A message will present asking Are you sure you cannot proceed with the work?
• Select the Yes button
• If a claim is registered add a case note to the claim using Restricted Claim Actions

Procedure ends here.

Note: for subpoenas received as unclassified documents, see Table 6 on the Process page in Authority to access a claim - Medicare Compensation Recovery

Documents may be classified by Kofax but sent to Work Optimiser - Health through the incorrect Source System. These documents require action to correct the Source System or redirect appropriately.

Is the document intended for MCR?

• Yes, go to Step 2
• No, go to Step 5

Is the Source System showing MCRS?

• Yes, see Table 1 on the Process page in Claim management - Medicare Compensation Recovery
• No, Source System is showing as Health Services, go to Step 3

• Select Download from the top right corner of the screen
• Save the document to the Redaction working folder in the shared drive through the Save as window that appears
• Save the document as a PDF
• Create a new email:
• add the attachment from the Redaction working folder
• update From to the Medicare Compensation Recovery mailbox
• update the subject line. Include the WIN and any other relevant details
• send the email to the Medicare Compensation Recovery inbox
• In Work Optimiser - Health:
• Select the Processing notes icon
• Add a processing note. In the text box add the following note
  ‘Work item was sent to Health Source System in error. Has been emailed to HIC inbox to correct Source System and process within MCRS’
• select Confirm to add the note
• Select the Details icon and change the Status dropdown to Complete
• Select Save from the bottom right corner to change the status of the item to completed

Note: Service Officers must make sure the document saved to their personal desktop is deleted once the above process is complete

Go to Step 4

• Use the Search Cases function in Restricted Claim Actions to locate and open the work item
• Use the Actions dropdown menu to Transfer assignment
• Select Operator in the Transfer to dropdown menu
• Select the Operator from the System button
• Enter your name or logon ID in the Operator field
• Confirm with the Transfer button
• Once MCRS instructs Work Optimiser- Health to assign the work item to your worklist, access the work item and process
• Procedure ends here

The Source System may show as Health Services or MCRS, however the document can be assessed as relating to a different Medicare program:

• Take a screen snip of the work item
• Send an email to local Team Leader:
• include the screen snip of the work item
• request the Team Leader to contact Workload Management team to re-direct the work item to the appropriate Program area

Note: do not unassign the work item. Workload management will remove the item from the worklist once email is actioned.

Procedure ends here.