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Medicare claims for deceased persons 011-43010070

This page explains details for Service Officers processing a claim when the deceased or their estate is the claimant.

Claims for deceased persons

Step	Action
1	Confirm identity of the executor or appointed administrator Has the executor or appointed administrator provided supporting documentation with the Medicare claim to confirm their identity? Yes, go to Step 3 No, go to Step 2
2	Search CDMS personal comments Service Officers must check the deceased’s personal comments in CDMS to see if confirmation of identity for the executor or appointed administrator have been previously provided. Has confirmation already been recorded in CDMS? Yes, go to Step 4 No, go to Step 6
3	Enter the executor or appointed administrator details in CDMS Service Officers must include in the deceased’s personal comment field in CDMS: full name of the executor or appointed administrator what documents have been sighted or provided, and the commencement date For example, Executor John Citizen certified copy last will and testament DD/MM/YYYY.
4	Check Safety Net registration Check Safety Net registration for the deceased and make sure they are not listed as the family contact (FC). See Register for Medicare Safety Net - Families, couples and children for more details.
5	Enter claim details Go to the claimant processing screen in Mainframe Using the details on the Medicare Claim form (MS014): Key NPOI,Medicare number (of the deceased person) Press [Enter]. Blank claimant identification fields display Key ‘B’ in the CTYPE field Key ‘Est of [claimant name]’ followed by a comma in Postal name field. For example, Est of John Citizen, Press [Enter] Confirm if the claim is paid (Y) or Unpaid (N) Press [Enter] Update the address to the claimant's correct address supplied on the form Complete claim details, see Patient claims processing in Medicare Procedure ends here.
6	Attempt phone contact Service Officers should attempt to phone the administrator or the executor before issuing the Z0828 - Medicare claim needs more information letter. Tell the administrator or the executor: before the claim can be processed, documents are needed to confirm their identity as the administrator or the executor the claim will be returned to them with an accompanying letter and that they will need to resubmit the claim with the appropriate documentation The Resources page contains a link to the Digital Messaging Capability (DMC) to create and send letters.
7	Send letter Service Officers must not process the claim. Send Z0828 - Medicare claim needs more information letter including the approved free text wording: 'We need to update our records before we can process your claim. You will need to submit a new claim with a certified true copy of either the last Will and Testament or the Letter of Administration.' The Resources page contains a link to the Digital Messaging Capability (DMC) to create and send letters. See Preparing, quality and peer to peer checking of Medicare external mail.