Cheque processing in Medicare 011-43090000

From 1 July 2016, Medicare benefits for fully paid accounts can only be paid by Electronic Funds Transfer (EFT). Funds are deposited into a nominated bank account.

Payment for claims is held until EFT details are provided if a claimant does not have:

• valid EFT details stored in CDMS, or
• cannot provide valid temporary or permanent EFT details at the time the claim is submitted

Claimant cheques

• Before 1 July 2016, Medicare could issue payments for fully paid accounts to a claimant by:
• cheque, or
• EFT
• Cheque payments to the claimant are identified by a payee code 5
• From 1 July 2016, all payments for fully paid accounts are made by EFT into the claimant's nominated bank account
• EFT payments to the claimant are identified by a payee code 9

See Store, confirm and end date bank account details for Medicare EFT payments for more details.

Pay doctor via claimant (PDVC) cheques

If a patient's unpaid or partially paid medical account is lodged for payment, Medicare sends the patient a PDVC cheque made payable to the health professional.

The claimant is then responsible for forwarding this cheque to the health professional, together with any outstanding account balance.

PDVC payments to the claimant are identified by a payee code 2.

For enquiries about a cheque not being received, Service Officers must check the status of the cheque before actioning the enquiry.

The BBEI and BBCI screens show the status of cheques payable to either a claimant or health professional.

Status of cheques can include:

• presented
• unpresented
• stopped
• cheque returned
• stale
• CEFT - paid via 90 Day Pay Doctor Cheque Scheme

The Resources page contains a list of Cheque enquiry control lines.

There is a minimum turnaround time for Medicare benefits. These minimum payment times vary according to the claiming channel.

The minimum payment times relate to the number of days (including weekends) Services Australia (the agency) holds the benefit before releasing the payment to the claimant.

• The count for the minimum payment time starts from the date the claim is lodged
• The minimum payment times are decided by Government in consultation with peak bodies

For minimum payment times, see Patient claim requirements for payment of Medicare benefits.

If a Medicare benefit needs to be repaid to the claimant, all Medicare benefits for patient claims will be paid by EFT. Where the account remains unpaid, PDVC cheque will be issued.

Reissue a benefit if a cheque has been:

• paid for incorrect amount
• lost, missing, stolen, destroyed or damaged
• returned
• unclaimed
• stale

At the first point of contact, where the agency has been notified by the claimant or health professional that a cheque needs to be reissued, the Service Officer must first check Mainframe to identify the status of the claim before reissuing or performing a cheque trace.

• A stop can be placed on a cheque if the cheque:
• is lost or missing
• is more than 14 days old, or
• not subject to the 90 day Pay Doctor Via Claimant (PDVC) cheque
• A health professional can stop, cancel or reissue a cheque only after it was in their possession, and it has been lost
• A cheque can be stopped immediately regardless of the age of the cheque, if the cheque is:
• stolen, destroyed or damaged, and
• not subject to the 90 day PDVC cheque

This does not cover instances if:

• the patient does not forward the pay doctor via claimant cheque to the doctor
• the doctor is seeking to have the cheque reissued to them at their practice

If a cheque is subject to the 90 day PDVC, do not stop or reissue the cheque.

If a 90 day cheque remains unpresented on the 91st day after the date of issue:

• the cheque automatically cancels, and
• payment is made by Electronic Funds Transfer

Unpresented cheque

A cheque can be cancelled and the Medicare benefit reissued to the correct recipient if the cheque is unpresented and has been incorrectly issued in favour of either the:

• health professional instead of a claimant
• incorrect health professional

Service Officers can cancel the cheque and the Medicare benefit reissued to the correct recipient.

When Service Officers reprocess the claim and the account/invoice is fully paid, the benefit must be paid to the claimant via EFT.

The agency must be in possession of a cheque before it is cancelled and reissued. If a claimant states a cheque has been paid incorrectly, they must be advised to return the cheque to the agency.

Where the claimant does not have possession of the cheque, see the Process page for what action must be taken to make sure payment is made.

Members of the public cannot endorse the back of the cheque to pay the funds to a health professional, as banks will not accept the cheque.

Unissued Cheque

When Service Officers receive enquiries from members of the public querying the status of their Medicare rebate, a cheque number may not display in Mainframe against the relevant paycode 2 line.

A cheque number may not display in Mainframe should the claim have been processed within the past 14-16 days. This is because the cheque is awaiting printing. For minimum payment times, see Patient claim requirements for payment of Medicare benefits.

Should the member of the public advise that they have paid the account in full on the date of service/claim transmission, the patient’s claiming history must be checked.

The claimant may be expecting a rebate via EFT; however a Medicare Pay Doctor via Claimant Cheque will be issued instead if the claim was:

• processed incorrectly by a Medicare Service Officer as an unpaid account, or
• transmitted electronically by the health professionals rooms as an unpaid/partially paid account

A cheque extraction cannot be requested if:

• the claim has been processed as an unpaid account (payee code 2), and
• the claim was transmitted electronically by the health professional

Cheque extractions are only to be requested for Medicare processing errors. For more details on requesting a cheque extraction see Process page, Request a cheque extraction.

The claimant is to wait for the cheque to be issued. Once received, the claimant is to return the cheque to the agency along with proof of payment. For more details see Process page, Cheque issued to wrong payee.

Presented cheque

When the cheque is presented, if the Service Officer is:

• trained in patient claim adjustments, the claim must be reprocessed as an overpayment, ensuring the Medicare benefit is made payable to the correct recipient
• not trained in patient claim adjustments and the claim is:
• in PaNDA, it is categorised to patient claim adjustments
• not in PaNDA, an Adjustment for Patient Claims form is completed and escalated to the MPS Assessing

Recovery action must be made in accordance with the agency's management of debt policies.

See also:

• Account and receipt documents for Medicare claims processing
• Latter day adjustments (LDA) and HELD payments for patient claims
• Process page

The following guidelines apply if a benefit has been processed incorrectly and a lesser or greater amount should have been paid.

For example, the service was paid as an out of hospital service (85% benefit) but should have been paid as an in hospital service (75% benefit).

Where an enquiry is received from a claimant who states a cheque has been paid incorrectly, they must be advised to return the cheque to the agency.

See the Process page for more instructions when the claimant does not have the cheque.

Cheques can be returned unclaimed where the agency holds an incorrect address for the claimant or an incorrect address has been submitted for an online claim.

If the returned cheque was made payable to the claimant, the Service Officer must check if EFT details have been stored on CDMS and re-direct payment to the stored bank account.

If the returned cheque was made payable to the health professional, the Service Officer must return the cheque to the system. See Return to Sender (RTS) mail for Medicare for details (Process RTS cheques).

The payment can be redirected via EFT if:

• the claimant makes an enquiry regarding an unclaimed cheque or the address has been updated, and
• the claimant has bank account details recorded

Service Officers must verify if an unclaimed cheque made payable to a health professional is eligible for the 90 Day Pay Doctor Cheque Scheme. The Process page contains more details on how to determine the status of a cheque and if it can be stopped.

Where it is identified that the cheque is:

• not associated with the scheme, see Return to Sender (RTS) mail for Medicare
• is associated with the scheme, see 90 Day Pay Doctor Cheque Scheme

The Resources page links to request this historical information on health professional enquiries - 90 Day cheque cancellation.

From 1 July 2016, only unpaid claims (PDVC cheques) will be issued via a cheque.

If Medicare has made a processing error for unpaid claims, Service Officers must identify whether a cheque extraction is possible and inform their Team Leader of the error.

If the health professional or claimant have incorrectly lodged a claim, a cheque extraction is not available.

The Process page explains how to request and action a cheque extraction.

All extracted cheques are marked 'VOID' unless otherwise advised. If a cheque is extracted but does not need to be cancelled, the cheque does not need to be marked.

See also Adjustments for Medicare patient claims.

Timeframes

In most cases, the maximum timeframe for a cheque extraction is 2 days short of the minimum payment time.

See also Patient claim requirements for payment of Medicare benefits.

If a Medicare processing error is identified outside these timeframes, at least 2 attempts must be made to contact the claimant by telephone and request that the cheque be returned to the agency for cancellation and reissue.

Where a person cannot attend a Medicare service centre, see the Resources page for postal details if a claimant must return the cheque via mail with a letter of explanation.

If additional support is required, contact Local Peer Support (LPS).

The system will automatically cancel the cheque when it is considered stale, 15 months after the date it is drawn. The Medicare benefit must be reissued if not previously paid. A stale cheque originally issued to the claimant will be reissued as an EFT payment. See Process page, Reissue a cancelled or stale cheque.

Where a cheque is more than 6 years old from date of issue, Medicare is unable to validate that no replacement cheque has been issued. Therefore, the Medicare benefit must not be reissued.

Return the cheque to the individual with the appropriate standard letter.

See also Using Standard Letter Templates (SLT).

For escalation if a cheque is more than 6 years old and the customer is claiming financial hardship or an escalated complaint, the Process page explains how to identify and action a stale cheque.

The agency automatically issues a statement of benefit for pay doctor via claimant (PDVC) cheques.

A statement of benefit contains information that may assist private health funds to identify services that may attract a fund gap benefit. When requested, a replacement statement of benefit can be issued. Service Officers must make sure that where a replacement statement is requested, it must only be issued to the claimant or patient for that service.

The Process page explains how to issue a duplicate statement of benefit.