Return to sender (RTS) mail for Medicare 011-20073009

Identify the RTS mail type.

If the RTS mail relates to:

• Medicare Customer and Lifetime Health Cover (LHC) Letter, go to Step 4
• Continence Aids Payments Scheme (CAPS), unassign and recategorise the work item in PaNDA to Miscellaneous (MISC_CAPS_RTS_STMT)
• Debt recovery letters, go to Step 2
• Child Dental Benefits Schedule (CDBS)
• see Table 3 in Patient eligibility for Child Dental Benefits Schedule (CDBS) in Medicare and complete the steps, then
• go to Step 4
• Provider registration, LSPN/diagnostic imaging equipment, bulk bill, simplified billing, and 90 Day Cheque cancellation letter to provider:
• mark the work item as Complete in PaNDA
• Provider pathology, unassign and recategorise the work item in PaNDA to Pathology (PROV-PATHCOL-RENEW)
• Australian Immunisation Register (AIR), go to Returned mail for AIR
• Australian Organ Donor Register (AODR), go to Action AODR returned mail
• Aged Care Services:
• recategorise the work item in PaNDA to AC_Residential (Aged Care Return Mail), and
• rename with the RACS/Service ID as PRIMARY ID using the Service Provider Number shown on the letter
• Veterans Affairs Processing (VAP) or Department of Veterans Affairs (DVA)
• mark the work item as Complete in PaNDA

Save the Work Item:

• right mouse click on the document
• select Save As
• save the document to the ‘Customer Information’ folder located on the team’s shared drive. Customer Information must not be saved to desktops or personal H drives
• rename the File name as the customer name
• select PDF (*.pdf) from the Save as type dropdown > Save
• go to Step 3

Open Microsoft Office Outlook.

Send the work item to the relevant business area:

• select New Email
• attach the document from the saved location
• send to the relevant business area:
• Medicare Debt Recovery, for debt recovery letters
• HIC Compensation Recovery mailbox, for RTS Medicare Compensation Recovery cheques
• select Official as the email classification > Send
• add a note to the PaNDA file to confirm the RTS mail has been sent to the relevant business area, stating: 'RTS mail sent to <business area> on DD/MM/YYYY, NFA'
• change the status of the PaNDA file to Complete
• Service Officers must delete the file from the saved location

Procedure ends here.

Log into CDMS:

• select Amend Consumer Details
• the Amendment Search screen displays
• conduct a Basic Search with the Medicare card number (if on the returned mail)
• if no matches, conduct an Address Search

Has the customer been identified?

• Yes, go to Step 5
• No, go to Step 6

Is the CDMS address different to the customer's address shown in the return mail?

• Yes, go to Step 6
• No, go to Step 7

Add a note to the PaNDA file stating RTS Mail - No action taken.

Go to Step 8.

In CDMS, set a return mail indicator on the customer's record.

If a Medicare card number is present, add to the Work Item Details - Medicare number section:

• update the status of the work item to complete. For help, see Work Optimiser for staff
• comments are not required to be added in PaNDA or CDMS

Identify the RTS cheque type.

If the RTS cheque relates to:

• Medicare Customer, go to Step 2
• Medicare Compensation Recovery RTS cheque, go to Table 1, Step 2
• Other, escalate to Local Peer Support (LPS) for assessment

If the details need to be sent via email to the relevant area, see Table 1, Step 2.

Open and log into Mainframe.

Search for the cheque details:

• key BBCI,NB?R,cheque number into the control line. Replace ? with the relevant state code the cheque was sent to. See Cheque processing in Medicare for a list of state codes
• press [Enter]

Do the cheque details display?

• Yes, go to Step 4
• No, the 1-NOT FND error displays. Go to Step 3

Search for the cheque details using other state codes:

• key BBCI,NB?R,cheque number into the control line. Replace ? with other state codes. See Cheque processing in Medicare for a list of state codes
• press [Enter]

The customer's Medicare number is the number next to CARD NO on the BBCI screen. Service Officers must add a digit to the end of the Medicare number, as the BBCI screen only displays 9 digits. Patient name can be found on cheque statement.

Do the cheque details display?

• Yes, go to Step 4
• No, the 1-NOT FND error displays. Go to Step 10

Health professionals eligible under the 90 day scheme are:

• GPs registered for the 90 Day Pay Doctor Cheque Scheme
• Specialists (including radiologists), consultant physicians, pathologists, and GPs for claims submitted electronically

Allied Health practitioners, Dentists, Optometrists, Midwives and Nurses are not eligible for the 90 Day Scheme.

All electronically transmitted claims are identified with a CLID line directly above the service line.

Access the Medicare claims history in Mainframe:

• key NHSI, card number, patient's IRN or first initial into the control line
• press [Enter]

Identify the date of service for the payment.

Do not use modifiers when searching history for CLID line.

Is the CLID line directly above the service line?

• Yes, go to Step 6
• No, go to Step 7

Determine if the claim was submitted electronically by the provider:

• Press [Shift] + [F2] to view Claim Type
• The CT (Claim Type) column displays the transmission type PCO - Patient claim online and easy claim

Is the claim showing PCO?

• Yes, go to Step 8
• No, go to Step 9

If the claim is not an electronic claim submitted by the provider, but the provider is a GP, the Service Officer must access Provider Directory System (PDS) to check if the GP is registered for the original 90 day scheme.

Access and log into PDS:

• Open the Services Australia intranet
• Go to My Tools
• Select Medicare Portal the Medicare - eBusiness Gateway displays
• Select the Source Office dropdown. An error message displays if no source office is selected
• Select Provider Directory Services (PDS) from the eBusiness System dropdown

From the menu:

• Select Provider Location then View
• Key the first 6 digits of the provider number in the Provider stem field
• Key the first alpha of the provider number in the Provider Location field
• Select Search

On the provider location detail screen, the bottom right view displays if the provider is registered for 90 Day Pay Doctor Cheque Scheme (Locn Reg for 90d Cheque).

Is the provider registered for the 90 Day Pay Doctor Cheque Scheme (Locn Reg for 90d Cheque)?

• Yes, go to Step 8
• No, go to Step 9

In Mainframe, add text to the BBCI screen

• select the first field under heading A
• key T to enter text information
• select Tab to go to the next field
• key RTS90 days and universal log on or operator number (P number), press [Enter]
• key U, press [Enter]

Go to Step 11.

In Mainframe, add text to the BBCI screen:

• select the first field under heading A
• key T to enter text information
• select Tab to go to the next field
• key RTS CHQ and universal log on or operator number (P number) press [Enter]
• key U, press [Enter]

Go to Step 11.

Search for the cheque status in Mainframe:

• key BATI,NB?R,cheque number into the control line. Replace ? with the relevant state code the cheque was sent to. See Cheque processing in Medicare for a list of state codes
• press [Enter]
• the cheque status is listed in the last row under Function

Does the cheque status display?

• Yes, note the cheque status. Go to Step 11
• No, go to Step 13

Log into CDMS:

• select Amend Consumer Details
• the Amendment Search screen displays

Is the CDMS address different to the customer's address shown in the return mail?

• Yes, go to Step 13
• No, go to Step 12

In CDMS, set a return mail indicator on the customer's record.

Comments are not required to be added in PaNDA or CDMS.

Go to Step 14.

Add a note to the PaNDA file stating RTS CHQ - No action taken.

Update the status of the work item to complete.