Skip to navigation Skip to content

Cheque processing in Medicare 011-43090000

This document explains cheque processing in Medicare.

On this page:

Determine status of a cheque and if it can be stopped

Stop a cheque using Medicare Mainframe

Reissue Medicare benefit for a returned cheque

Identify a stale cheque

Reissue a cancelled or stale cheque

Request a cheque extraction

Claimant expected payment by cheque

Cheque issued to wrong payee

Cheque adjustment and updating service details

Medicare benefits processed incorrectly

Resolve payment when extraction is returned

Identify a doctor registered for the 90 Day Pay Doctor Cheque Scheme

Process Stopped Payment Lodgement (BSCI) and Accepted Stop Totals (BILI) reports

Determine status of a cheque and if it can be stopped

Table 1

Step	Action
1	Determine the cheque type and cheque status Key NHSI,Medicare card number,IRN in the control line and press [Enter] Identify the date of service for the payment Identify the payee code of the service Press [F10] key to display the cheque number and status of the cheque The Resources page contains more details on cheque status.
2	Payee 2 code is PDVC cheque Identifying 90 Day Cheques or PDVC. Eligible health professionals who have PDVC or (payee 2 code cheques) issued are either: GPs registered for the 90 Day Pay Doctor Cheque Scheme, or GPs, specialists (including radiologists), consultant physicians, or pathologists who have submitted claims electronically See Table 12. Allied health professionals are not eligible to be part of the 90 Day Cheque Scheme. Ask the customer if the payment is for an Allied health professional or refer to 90 Day Pay Doctor Cheque Scheme Registration in Provider Directory System (PDS). When the payee identifies as an Allied health professional, go to Step 3. All electronically transmitted claims are identified with a CLID line directly above the service line. To identify if a claim was electronically submitted by the health professional: Press [Shift] + [F2] to view the Claim Type (CT) The CT column will display the transmission type PCO - Patient claim online and easyclaim When operators identify that the payee 2 code cheque issued is part of the 90 Day Pay Doctor Cheque Scheme, the claimant must be advised that the: cheque is part of the 90 Day Pay Doctor Cheque Scheme payment will automatically be deposited on the 91st day after the issue date into the eligible health professional's bank account This does not include when the claimant has paid for the service in full. In this situation the cheque can be cancelled and paid to the claimant. For how to cancel the cheque and pay the claimant see Table 8. Procedure ends here. Donot use modifiers other than DOP/DDMMYY to refine the search as this will remove the CLID line from patient history.
3	Identifying lost or missing cheques The Service Officer may be required to place a stop on the cheque, if the claimant advises that a cheque is lost or missing and the cheque: is more than 14 days old has unpresented status, and was not electronically transmitted by a health professional who is eligible for the 90 Day Pay Doctor Cheque Scheme If the cheque does not meet the criteria above, a stop must not be actioned. To determine the status of the cheque, in Mainframe: key BBCI,NB?R,cheque number in the control line Note: to replace the '?' in the control line, see the state codes on the Resources page press [Enter] The Cheque enquiry screen will display the status of the cheque and if the cheque has been returned to the agency. Text display: RTS 90DAYS, see Table 12 RTS CHQ, see Table 5 No text displayed - the cheque is not in the agency’s possession and is awaiting presentation. These cheques, if reported as lost or missing, can be stopped. See Table 2 Proof of payment is required if Stop cheque and reissue payment form indicates the original cheque is over $100 and the payee code has changed from 2 to 9. Cheques must only be stopped if they: have an unpresented status are not identified as a 90 Day Cheque, and are not identified as ‘returned, stale or cancelled cheques’ Placing a stop on a cheque does not cancel it. The payment cannot be issued until the cheque has been stopped by the Reserve Bank of Australia. Complete the Stop cheque and reissue payment form. The Resources page contains a link to the Stop cheque and reissue payment form. Go to Step 4.
4	Identifying stolen, damaged or destroyed cheques If cheques are reported as stolen, destroyed or damaged, there is no requirement to wait 14 days before stopping the cheque. Confirm via the Cheque enquiry screen the status of the cheque and if the cheque has been returned to the agency. In Mainframe: Key BBCI,NB?R,cheque number in the control line Note: to replace the '?' in the control line see the state codes on the Resources page Press [Enter] The Cheque detail screen will display the status of the cheque and if the cheque has been returned to agency. Text display: RTS 90DAYS, see Table 12 RTS CHQ, see Table 3 No text displayed - the cheque is not in the agency’s possession and is awaiting presentation these cheques if reported as lost or missing can be stopped. See Table 2 Only stop cheques that: have an unpresented status, are not identified as 90 Day Cheque, and are not identified as ‘returned, stale or cancelled cheques’ Complete the Stop cheque and reissue payment form. The Resources page contains a link to the Stop cheque and reissue payment form Procedure ends here.
5	Escalation process If Service Officers need help to finalise an outcome for a claim, contact Local Peer Support (LPS).
6	LPS escalation process If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to the Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Stop a cheque using Medicare Mainframe

Table 2

Step	Action
1	Identify the service If a customer presents at a Service Centre or calls to enquire about a payment of a claim, perform a security check and confirm the identity of the patient/claimant before identifying the status of the cheque. To determine the status of the cheque in mainframe: Key BBCI,NB?R,cheque number in the control line Note: to replace the '?' in the control line see the state codes on the Resources page Press [Enter] and the Cheque details screen will display The Status field will display the current status of the cheque.
2	Stop the cheque Cheques must only be stopped if they: have an unpresented status are not identified as 90 Day Cheque, and are not identified as 'returned' To stop a cheque: place the cursor in action field (under the letter A) and key ‘S’ to indicate that the cheque is being stopped in the Text field: Key reason for stop, for example, LOST, DAMAGED, STOLEN (Abbreviate if required) Service Officer’s source office code Service Officer’s operator number press [Enter]. The control line will change from BBCI to BBCC key ‘U’ into the control line (BBCU) and press [Enter]
3	Stop cheque and reissue payment form Complete the relevant section of the Stop cheque and reissue payment form, the Resources page contains a link the form Save the form as a PDF with the following file name: YYYYMMDD.[State Code].[Cheque Number].STPCHQ For example: 20200907.N12345678.STPCHQ Email the form with STOP CHEQUE in the subject line to MPS Assessing Placing a stop on a cheque does not cancel it. The payment cannot be reissued until the cheque has been stopped by the Reserve Bank of Australia. Procedure ends here.
4	Escalation process Where Service Officers require assistance to finalise an outcome for a claim, contact Local Peer Support (LPS).
5	LPS escalation process Where LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to the Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Reissue Medicare benefit for a returned cheque

Table 3

Step	Action
1	Security check Complete a security check with the claimant. Get sufficient service information from the claimant such as: health professional's name and location approximate date of service (DOS) charge
2	Confirm if the cheque has been returned to the agency Cheque adjustments can only be actioned when the agency is in possession of the cheque. In Mainframe: key NHSI,Medicare card number,IRN or select patient in the control line locate the service press [F10] to locate the cheque number and display the status of the cheque key BBCI,NB?R,cheque number in the control line Note: to replace the '?' in the control line. See the state codes on the Resources page press [Enter] The Cheque detail screen will display the status of the cheque and if the cheque has been returned to the agency. The text listed below indicates that the agency has possession of the cheque. Text display: RTS 90DAYS, see Table 12 RTS CHQ, go to Step 3 No text displayed - the cheque is not in possession of the agency and cannot be reissued RTS cheques must be reissued when the cheque is payable to an Allied health professional and for a service not eligible for 90 Day Pay Doctor Cheque Scheme. See Table 2.
3	Return the cheque to the original claim screen Key NAQI,cheque number,?,date of issue in the control line Note: to replace the '?' in the control line see the state codes on the Resources page Press [Enter] In the ADJ field, key ‘LCR’ [Tab] to CHQ TX field and key reissue payment and press [Enter] U to update The original claim screen displays. If the system returns any of the following return messages, add a Processing Note in PaNDA and proficiency raise the claim. 8-INCOMP I-BEN<CHQ 8 BEN<CHQ
4	Assessing the claim Confirm address by keying the first two letters of the street ADR field line (for a PO Box, key the first 2 letters of the suburb) In the PAID field select either: ‘Y’ for paid accounts ‘N’ for unpaid accounts If paid account: Over key all '2's in the 'P' column to '-' then press [F4] to display stored bank account details In the EFT field, key ‘C’ In the STM field, key ‘P’ Press [Enter] If no EFT details are stored or provided in the EFT field, key ‘N’ No EFT. This will allow validation of the EFT details to be bypassed for the assessment of the claim to continue. The benefit will be held until EFT details are provided Review and apply the assessing restrictions by following warning messages. Warning messages must be actioned in order from left to right. Further explanations can be viewed by placing the cursor at the beginning for the return message and pressing [F1]
5	Finalising the claim When reissuing a payment, always make sure reason code '205'is displayed in the RSN field to indicate the original service has been repaid Press [Enter] Key ‘P’ to pay claim The repayment benefit amount should equal the amount that was originally paid. However, there are circumstances when this amount will change as the Safety Net or other assessing rules such as adjustments from out - to - in patient services will impact the repayment amount. Where warning message 1 SNET PND directs to PEND the claim escalate for assessment by experienced staff: Select the HOME key and overtype the control line with ‘NPND’ (to pend the claim) In PaNDA - Add a Processing Note to the work item and proficiency raise All ART/IVF services (item numbers (13200-13251) are to be pended and in PaNDA - Add a Processing Note to the work item and proficiency raise. See Work Optimiser for staff Procedure ends here.
6	Escalation process If Service Officers need help to finalise an outcome for a claim, contact LPS.
7	LPS escalation process If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to the Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Identify a stale cheque

Table 4

Step	Action
1	Status of a stale cheque To identify the status of a cheque: Key NHSI,Medicare card number,IRN in the control line Press [Enter] Identify the date of service for the payment Identify the payee code of the service Press [F10] to display the cheque number and status of the cheque Stale cheques will have the status of 'LSC' Cheques with an issue date between 1 day and 15 months A cheque is not considered stale until 15 months after the date it is drawn. Cheques that have not yet reached 15 months can still be banked. Cheques with an issue date between 15 months to 72 months (6 years) The system will automatically cancel the cheque, as it has become stale. The cheque status will appear as ‘LSC’. Where the claimant: does not have the cheque, advise the claimant that if the cheque is found or received at a later date they may incur a fee if they attempt to bank the cheque does have the cheque, request it is returned to the agency Check the cull date on customer's claims history. If cheque was issued before the cull date and the claim cannot be located on history, press [F9] to locate the customer's PIN. Use NHSI,(PIN) to search, and look for the claim or date of service to confirm cheque status of 'LSC'. The SAS report can be checked (by a Service Officer with access to the report) if no information on history. Cheque with an issue date that is more than 6 years old Where a cheque is more than 6 years old, Medicare is unable to validate that there has been no replacement cheque issued. Do not reissue the cheque. Return the cheque to the individual with the letter Z1929 - Medicare Benefits - not able to reissue stale cheque over 6 years old. See also: Using Standard Letter Templates (SLTs) to create manual letters. For national consistency, the agency has set the limitation period to 6 years from the date the person was entitled to payment of Medicare benefits (the day the cheque was issued). For escalation where a cheque is more than 6 years old from date of issue and the customer is claiming financial hardship or an escalated complaint, go to Step 2 For escalation to LPS, for example for system issues or item restrictions, go to Step 3
2	Escalation due to financial hardship If the customer is claiming financial hardship the below information must be verified: Claim details to verify if the service has been re-paid (DOS, Item number, Charge amount, Provider number, Referral details if applicable) Copy of the cheque Over 5 year history report requested via SAS Portal to verify if service has been previously re-paid (if Service Officer does not have access to SAS Portal then this can be requested via LPS) Once all of the above information is used to verify that the service was not previously re-paid, a request for a manual EFT can be sent to the Policy and procedural queries inbox for actioning. Include all documentation in the email. Note: if the above information cannot be obtained, tell the customer that Medicare is unable to verify there has been no replacement cheque/EFT payment issued without all the service details of the claim. Procedure ends here.
3	LPS escalation process If Service Officers need help to finalise an outcome for a claim, staff must refer to Local Peer Support (LPS) in the first instance. If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Reissue a cancelled or stale cheque

Table 5

Step	Action
1	Security check To complete a security check with the claimant, see Table 1. Get sufficient service information from the claimant such as: servicing health professional's name and location approximate date of service (DOS) charge If the claimant differs from the original claimant, the procedure ends here.
2	Identifying the service Key NHSI,Medicare card number,patient or IRN in the control line Press [Enter] Locate the stale or cancelled cheque on history Use modifier SORT/DOS to refine search to date of service only. Patient history displays the following reason codes: UCS identifies a cancelled cheques LSC identifies a stale cheques 205 identifies when the original claim has been repaid 999 identifies the original claim details Verify that the cheque was not previously reissued. The 999 line will provide all the original details of the claim and Service Officers must use this information to reissue the payment. Key NHSI,Medicare card number,DOP/DDMMYY in the control line Note any details required to reprocess the claim. For example, referral details, LSPN numbers etc. If the 999 line is not present and claim details are missing, contact LPS for assistance.
3	Processing the repayment of the original claim Key NPOI,Medicare card number and press [Enter]. The claim may default to the basic processing screen. Press [F2] to display full processing screen. Select claimant PAID field, select either: ‘Y’ for paid accounts ‘N’ for unpaid accounts Press [Enter] Confirm address by keying the first two letters of the street ADR field line (for a PO Box, key the first 2 letters of the suburb) If paid account: then press [F4] to display stored bank account details EFT field, key ‘C’ for confirm STM field, key ‘P’ for permanently stored EFT details press [Enter] If no EFT details are stored or provided in the EFT field key N for ‘No EFT’ to allow validation of the EFT details to be bypassed and for the assessment of the claim to continue. Benefit will be held until EFT details are provided Enter the date of Lodgement as the date the agency received the request
4	Assessing the claim Review and apply assessing restrictions by following warning messages. Warning message must be actioned in order from left to right. Further explanations can be reviewed by placing the cursor at the beginning of the return message and pressing [F1].
5	Finalising the claim When reissuing a payment, always make sure reason code ‘205’ displays in the RSN field to indicate the original service has been repaid. Press [Enter] Key P to pay claim The repayment benefit amount must equal the amount that was original paid. There are circumstances when this amount will change as the repayment amount may be impacted by the safety net or other assessing rules. Check these amounts before paying the account.
6	Pending claims for escalation If the repayment benefit amount exceeds the original payment amount or where a warning message (for example, 1-SNET PND) directs to PEND the claim for escalation for assessment by experienced staff. Select the HOME key and overtype the control line with ‘NPND’ (to pend the claim) Proficiency raise the claim in PaNDA All ART/IVF services (item numbers (13200-13251) are to be pended, a Processing Note added to PaNDA and the work item proficiency raised.
7	Escalation process for experienced staff requiring assistance If experienced staff need help to finalise an outcome for a claim, staff must refer to Local Peer Support (LPS) in the first instance.
8	LPS escalation process If LPS identifies a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Request a cheque extraction

Table 6

Step	Action
1	Identifying the service Only extract a cheque if a Medicare Processing error has been identified. Identifying the service that requires a cheque extraction: Key NHSI,Medicare card number,IRN and press [Enter] Identify the date of service for the payment Identify the payee code of the service Press [F10] to display the status of the cheque See also Table 1.
2	Determining if the cheque is able to be extracted The maximum timeframe for a cheque extraction is 2 days less than the minimum payment time for the claim. See also Patient claim requirements for payment of Medicare benefits. If a processing error is identified outside these timeframes, make at least two attempts to contact the claimant by telephone and request that the cheque be returned to the agency for cancellation and reissue. If the claimant cannot be reached by phone, send a letter requesting return of the cheque. If a person cannot attend a service centre, they must return the cheque by mail with a letter of explanation. See the Resources page for contact details. If the claimant cannot or refuses to return the cheque to the agency, escalate to LPS.
3	Cheque extraction form Complete the Cheque Extraction Request form, see the Resources page for a link to the form The Cheque Extraction Request form must have all fields completed and clearly provide sufficient information to assist with how the payment should be resolved Production control will also be guided by the instructions provided by the requestor in the cheque extraction form. Note: email the form to Output Management team, Digital Projects Branch staff will be notified that the cheque extraction has been either unsuccessful or it has extracted and securely destroyed sent emails are recognised by the agency as a corporate record
4	Update CDMS personal details regarding request for cheque extraction Enter requests to extract the cheque on the personal records of the claimant. Standard text: Cheque extraction for patient [if different to claimant] service DDMMYY prov/XXXXX requested on DDMMYY. This information will assist the agency in resolving enquiries should the claimant make further enquiries. Update the Amend Personal Details screen. Procedure ends here.
5	Escalation process If Service Officers need help to finalise an outcome for a claim, contact Local Peer Support (LPS).
6	LPS escalation process If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Claimant expected payment by cheque

Table 7

Step	Action
1	Claimant did not request EFT Claimant advises that they did not ask for payment by Electronic Funds Transfer (EFT) and were expecting payment by cheque. Does the claimant have bank account details stored? Yes, go to Step 2 No, go to Step 3
2	Bank account details stored Advise the claimant: 'We currently have your bank account details stored with us to use for payments. The agency no longer pays Medicare benefits by cheque’. If the claimant has not received the benefit, see Medicare Benefit not received (EFT dispute). Procedure ends here.
3	Bank account details not stored Check if there are bank account details against the paid claim. To check if they are temporary: press [F10] on the patient's history screen press [F1] under the account details for the claim in question stored bank account details are either: (P) permanent (T) temporary If bank account details are (T) temporary, they are only used for that claim. If the health professional submitted the claim, the customer may have supplied bank account details that have resulted in the Medicare benefit being paid via EFT. Advise the claimant: 'This claim was submitted to Medicare by your doctor's practice and included your EFT details. As a result of this, the Medicare benefit has been paid into that bank account. If you do not want to receive Medicare benefits to this account, please advise your doctor's practice'. If no bank account details were provided for the claim, the claim will be HELD until bank account details are provided. If the claimant has not received the benefit, see Medicare Benefit not received (EFT dispute).

Cheque issued to wrong payee

Table 8

Step	Action
1	Has cheque been presented? Yes, go to Step 2 No, go to Step 3
2	If the cheque is presented An adjustment must be made. If an overpayment was made, recovery action must be made in accordance with the agency management of debt policies. See also: Latter day adjustments (LDA) and HELD payments for patient claims Account and receipt documents for Medicare claims processing Payments, refunds and debts for Medicare Compensation Recovery
3	Prepare to cancel and re-issue Medicare benefit Before cancelling and re-issuing a Medicare benefit, the Service Officer must: Possess the cheque Note: if the claimant does not have the cheque, see Determine the status of a cheque and if it can be stopped table Verify the account details by either: sighting an original account/invoice or receipt provided by the claimant contacting the health professional to request a faxed copy of the original account/invoice or receipt contacting the health professional and recording a comment on the PaNDA file getting a copy of the account/invoice from archives
4	Cancel cheque In Mainframe: Key NAQI,cheque number,?,date of issue in the control line and press [Enter] Note: replace the '?' in the control line. See the State codes for cheque processing on the Resources page In the CHQ TXT field, type a brief description of the reason for adjustment, for example, wrong claimant or wrong patient In the ADJ field use the following codes to action the requested adjustments: 'LCR' - to reissue payment or amend claimant/health professional, items, dates, charge amounts, or referral details. This will reopen the Patient claim screen for amendment/reissue 'LOC' - to cancel cheque payment where no further action is required Key ‘U’ to update and press [Enter] If the claim was processed with incorrect claim details, over key the incorrect details with the correct details.
5	Finalising the claim When reissuing a payment after it has been cancelled: Always make sure reason code ‘205’ is keyed in the RSN field to indicate the original service has been repaid Confirm payee code is correct for the reissue of payment If account is paid: Key ‘Y’ in the PAID? Field Over key all ‘2’ in the ‘P’ column to ‘-’ Press [F4] to change to EFT payment screen Where no EFT details are stored or provided key ‘N’ (No EFT) in EFT field to allow validation of the EFT details to be bypassed and for the assessment of the claim to continue. Benefit will be held until EFT details are provided If the account is unpaid: Key ‘N’ in the PAID? Field Press [Enter] Key ‘P’ to pay claim If Cheque is: In PaNDA - complete the work item Not in PaNDA - stamp or endorse the cheque with the word ‘cancelled’ and batch the cheque in the daily work The repayment benefit amount must equal the amount that was originally paid. There are circumstances when this amount will change as the repayment amount may be impacted by the Safety Net or other assessing rules. Check these amounts before paying the account. If the repayment benefit amount is different to the original payment amount or a warning message (for example, 1-SNET PND) directs to PEND the claim for escalation for assessment by experienced staff: Select the HOME key and overtype the control line with ‘NPND’ (to pend the claim) Proficiency raise the claim in PaNDA All ART/IVF services (item numbers (13200-13251) are to be pended, a Processing Note added in PaNDA and the work item proficiency raised.

Cheque adjustment and updating service details

Table 9

Step	Action
1	Assess cheque adjustment request Cheque adjustments can only be actioned: when the agency is in possession of the cheque, and the cheque is accompanied by instruction/evidence from the health professional/claimant of changes required Read the request attached to the cheque to identify the action required. Key NAQI,cheque number,?,date of issue in the control line Note: to replace the '?' in the control line see the state codes on the Resources page If the cheque has been cancelled or paid via 90 Day Pay Doctor Cheque Scheme, the claimant/health professional needs to be notified so the account can be reconciled between them If the health professional requests an overpayment adjustment to be actioned, see Latter day adjustments (LDA) and HELD payments for patient claims.
2	Key text In the CHQ TXT field type a brief description of the reason for adjustment, for example, paid in full, work cover, billing error, wrong claimant or duplicate payment.
3	Key adjustment action code In the ADJ field use the following codes to action the requested adjustments: ‘LCR’ - to reissue payment or amend claimant/health professional, items, dates, charge amounts or referral details. This will reopen the Patient claims screen for amendments or reissue ‘LOC’ - to cancel cheque payment for accounts paid by work cover, cancel duplicate payments for the same account, or to cancel the entire service Key ‘U’ to update and press [Enter] To action adjustments with LCR, the Service Officers must have the amended/itemised account. Amended account is missing or not acceptable Where the amended account is missing or not acceptable: the Service Officer must attempt to contact the health professional at least once to request a faxed amended account, or the required information to be taken over the phone and notated on a VG4 form The Resources page contains a link to the VG4 form or in PaNDA. If the Service Officer is unable to contact the health professional, the documents are to be returned to the claimant with the appropriate standard letter template.
4	Processing a cheque adjustment Adjust the claim by over keying the correct information on the patient claim processing screens. The following amendments can be made on the Patient claims screen: change payee code change claimant amend item number amend date of service (DOS) amend charge amount amend health professional details amend referral details Follow the prompts: Identify the claimant Confirm if the claim is paid (Y) or unpaid (N) Press [Enter] Verify the address: Key the first 2 letters of the street name in the ADR field line. For PO Box, key the first 2 letters of the suburb For a paid claim and payment is to be made by EFT: Key ‘Y’ in the PAID? field Over key all ‘2’ in the ‘P’ column to ‘-’ Press [F4] to change to EFT payment screen Key ‘C’ in the EFT field if using stored EFT details alternatively, if other EFT details are to be used for payment of claim, over key the existing EFT details and key ‘P’ for permanent to store EFT details, or ‘T’ to use temporary details for the claim Key ‘P’ in the STM field to issue a statement to the claimant key date of lodgement in the DOL field Update the details of the claim by over keying the: patient item date of service (FST DT) provider number payee code charge Once the details are correct, press [Enter].
5	Assessing the claim Review and apply assessing restrictions by following warning messages. Warning messages must be actioned in order from left to right. Further explanations can be viewed by placing the cursor at the beginning of the return message and pressing [F1].
6	Finalising the claim When reissuing a payment after it has been cancelled, always make sure reason code ‘205’ is keyed in the RSN field to indicate the original service has been repaid. Confirm the adjusted details Press [Enter] Key ‘P’ to pay the claim If the Cheque is: in PaNDA, complete the work item not in PaNDA, stamp or endorse the cheque with the word ‘cancelled’ and batch the cheque in the daily work
7	Escalation process If Service Officers need help to finalise an outcome for a claim, contact Local Peer Support (LPS).
8	LPS escalation process If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to the Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Medicare benefits processed incorrectly

Table 10

Step	Action
1	Identify cheque Is the cheque presented or unpresented? presented, go to Step 3 unpresented, go to Step 2
2	Cheque unpresented If the cheque is unpresented: Verify the account details Any of the following may be acceptable verification: Contact the health professional or hospital and record the details on a VG4 form or in PaNDA Sight an amended account Check the patient history A faxed copy of the original account Get a copy of the account from archives If the information can be verified, cancel the cheque using LCR and issue using RSN 205. See Table 9 If the information cannot be verified, the claimant must get an amended account so that the cheque can be reissued Verbal verification from a claimant is not acceptable.
3	Cheque presented If the cheque is presented: an adjustment must be made and an overpayment was made; recovery action must be made in accordance the agency management of debt policies See also: Latter day adjustments (LDA) and HELD payments for patient claims Account and receipt documents for Medicare claims processing Payments, refunds and debts for Medicare Compensation Recovery
4	Escalation process If Service Officers need help to finalise an outcome for a claim, contact Local Peer Support (LPS).
5	LPS escalation process If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system amend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to the Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Resolve payment when extraction is returned

Table 11

Step	Action
1	Log on to Mainframe Key NAQI,cheque number,?,date of issue in the control line Note: issue date can be taken directly from the cheque. To replace the '?' in the control line, see the state codes on the Resources page Establish how the payment will be resolved based on the information on the extraction request Is the payment to be reissued? Yes, go to Step 3 No, go to Step 2
2	Payments not to be reissued Key the adjustment code ‘LOC’ (not case sensitive) in the ADJ field to indicate that the payment is not to be reissued Press [Enter] Over key ‘NABC’ with ‘NABU’ or ‘U’ to adjust Press [Enter] Go to Step 7
3	Payment to be reissued Key the adjustment code ‘LCR’ in the ADJ field Press [Enter] Over key ‘NABC’ with ‘NABU’ or ‘U’ to adjust Press [Enter] Medicare Patient claims screen will display details of the original claim. If the system returns any of the following, escalate the claim: 8-INCOMP 1-BEN<CHQ 8 BEN<CHQ In PaNDA, add a Processing Note and proficiency raise the claim.
4	Processing the repayment Adjust the claim by over keying the correct information on the patient claim processing screens. The following amendments can be made on the Patient claims screen: change payee code change claimant amend item number amend date of service (DOS) amend charge amount amend health professional details amend referral details Follow the prompts: Identify the claimant Confirm if the claim is paid (Y) or unpaid (N) Press [Enter] Verify the address: Key the first two letters of the street name in the ADR field line. For PO Box, key the first two letters of the suburb For a paid claim and payment is to be made by EFT: Key ‘Y’ in the PAID? field Over key all ‘2’ in the ‘P’ column to ‘-’ Press [F4] to change to EFT payment screen Key ‘C’ in the EFT field if using stored EFT details Alternatively, if other EFT details are to be used for payment of claim, over key the existing EFT details and key ‘P’ for permanent to store EFT details, or ‘T’ to use temporary details for the claim Key ‘P’ in the STM field to issue a statement to the claimant Key date of lodgement in the DOL field Key the details of the claim patient item date of service (FST DT) provider number payee code charge Once the details are correct, press [Enter]
5	Assessing the claim Review and apply assessing restrictions by following warning messages. Warning messages must be actioned in order from left to right. Further explanations can be viewed by placing the cursor at the beginning of the return message and pressing [F1].
6	Finalising the claim Key the appropriate reason code '205' into the RSN field on the patient history to indicate the original service has been repaid Press [Enter] Key ‘P’ to pay the claim Add a Processing Note in PaNDA including the date the email was received from Output Management team stating that the cheque extraction was successful and cheque was destroyed Record a comment in CDMS with action taken Procedure ends here
7	Escalation process If Service Officers need help to finalise an outcome for a claim, contact Local Peer Support (LPS).
8	LPS escalation process If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to Medicare Claims Helpdesk and Support The Resources page contains a link to the escalation forms.

Identify a doctor registered for the 90 Day Pay Doctor Cheque Scheme

Table 12

Step	Action
1	Pay doctor via claimant cheques Before stopping a cheque Service Officers must always check to see if the health professional is part of the 90 Day Pay Doctor Cheque Scheme: Claims transmitted electronically by the health professional are automatically part of the 90 Day Pay Doctor Cheque Scheme General Practitioners (GPs), specialists (including radiologists), consultant physicians and pathologists are eligible to participate in the scheme Allied health professionals, optometrists and dentists are not eligible to participate in the scheme. All electronically transmitted claims have a CLID line above the service line.
2	How to identify cheques under the 90 Day Pay Doctor Cheque Scheme Access the Medicare claims history: Key NHSI,card number,patient's IRN or first initial in 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 3 No, go to Step 4
3	CLID line directly above the service line Determine if the claim was submitted electronically by the health professional: Press [Shift] + [F2] to view Claim Type The CT (Claim Type) column will display the transmission type PCO - Patient claim online and easyclaim Is the claim showing PCO? Yes, tell the claimant that as the claim was submitted electronically by the health professional, the cheque is automatically part of the 90 Day Pay Doctor Cheque Scheme. The health professional will receive their benefit after the 90 days have elapsed. Procedure ends here No, go to Step 4
4	CLID line is not above the service line If the claim is not an electronic claim submitted by the health professional, but the health professional is a GP the Service Officer must access Provider Directory System (PDS) to check if the GP is registered for the original 90 Day Pay Doctor Cheque Scheme. Access and log into PDS Select from the menu, Provider Location then View Key the first six 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 will display if the health professional is registered for 90 Day Pay Doctor Cheque Scheme (Locn Reg for 90d Cheque). Is the health professional registered for the 90 Day Pay Doctor Cheque Scheme (Locn Reg for 90d Cheque)? Yes, go to Step 5 No, go to Step 6
5	Health professional registered for 90 Day Pay Doctor Cheque Scheme Tell the claimant because the health professional is part of the 90 Day Pay Doctor Cheque Scheme the health professional will still receive their benefit after the 90 days have elapsed if the cheque is lost. Procedure ends here.
6	Health professional not registered for 90 Day Pay Doctor Cheque Scheme When health professional is not registered, the cheque can be stopped or cancelled.

Process Stopped Payment Lodgement (BSCI) and Accepted Stop Totals (BILI) reports

Table 13

Step	Action
1	Check Stopped Payment Lodgement (BSCI) report In Mainframe: Key BSCI,NB?R,DDMMYY in the control line Note: for the purpose of the Stopped Payment Lodgement (BSCI) report, the DDMMYY is the previous day processing date To replace the '?' in the control line see the state codes on the Resources page Press [Enter] The Stopped Payment Lodgement report will generate. This report provides the following details of stopped cheques: cheque number cheque amount issue date
2	Collating stop cheque and reissue of cheque forms Forward all stop cheque and reissue of cheque forms requests to MPS Assessing positional email account for collation and checking. Form not completed correctly Where stop cheque and reissue of payment forms have not been received or completed correctly: the stop on the cheque must be lifted, and the form returned to the requesting Service Officer with information to support them to progress the request Form correctly completed Correctly completed forms are held in date of stop order for processing. They are processed when available according to the Accepted Stop Totals (BILI) report.
3	Lifting a stop cheque In Mainframe: Key BBCI,NB?R,cheque number in the control line Note: to replace the '?' in the control line see the state codes on the Resources page Press [Enter] Cheque details screen is displayed: Place the cursor in the ‘A’ (Action field) and key ‘L’ to lift the stop TEXT field, key reason for lift Press [Enter] Key ‘U’ into the control line (BBCU) and press [Enter] The cheque has now been lifted and will be returned to UNPRESENTED status the next working day.
4	Check BILI report In Mainframe: Key BILI,NB?R,STOP in the control line Note: to replace the '?' in the control line see the state codes on the Resources page A report will be generated that provides the following details of all accepted stop cheques: cheque number reference (claimant's Medicare card number) date the cheque was stopped total amount of the cheque stopped
5	Reissue payment Payments must be reissued from the Stop cheque and reissue payment form to make sure the payment is correctly processed. Key NAQI,cheque number,?,date of issue in the control line Note: to replace the '?' in the control line, see the state codes on the Resources page Tab to the ADJ field and key: ‘LCR’, to reverse and reissue payment, or ‘LOC’, to not reissue the payment Note: select only the services related to that particular cheque Press [Enter] Over key NAQC or ‘U’ to adjust Press [Enter] Patient claim processing screen will display. If the system returns any of the following, escalate the claim: 8-INCOMP 1-BEN<CHQ 8 BEN<CHQ In PaNDA, add a Processing Note and proficiency raise the claim.
6	Processing the repayment The patient claim processing screen will open to the original processing details. Reissue payments from the Stop cheque and reissue payment form to make sure the payment is correctly processed. Follow the prompts: Identify the claimant Verify the address Key the first 2 letters of the street name in the ADR field line. For a PO Box address key the first 2 letters of the suburb Confirm if the claim is paid or unpaid Insert a ‘Y’ if the claim is being paid via EFT Over key all ‘2’ in the ‘P’ column to ‘-’ Press [F4] to reveal EFT payment Key ‘C’ in the EFT field if using stored EFT details. Alternatively, if other EFT details are to be used for payment of claim, over key existing EFT details and key ‘P’ for permanent to store EFT details, or ‘T’ to use temporary details for the claim Key ‘P’ in the STM field to issue a statement to the claimant. If no statement is required key ‘N’ in the STM field The original date of lodgement will show the DOL field Verify the details on the screen and correct any errors: patient item date of service (DOL) provider number payee code charge Once the details are correct, press [Enter].
7	Assessing the claim Review and apply assessing restrictions by following warning messages. Warning messages must be actioned in order from left to right. Further explanations can be viewed by placing the cursor at the beginning of the return message and pressing [F1]. Claim cannot be completed If reissue of payment cannot be completed due to ART, complex pathology, oncology etc: Pend the claim in Mainframe by over keying the control line with NPND and then press [Enter] For Claims in PaNDA proficiency raise For claims outside PaNDA email to MPS Assessing Procedure ends here Finalising the claim Reason code '205' will automatically populate the RSN field indicating the payment is a reissue of a previously cancelled cheque. Key ‘P’ to pay claim Note: if return message 6-CHG HIGH displays over key reason code 205 with reason code 523 and select Enter. Then re-key reason 205 before finalising the payment. Procedure ends here.
8	Escalation process If Service Officers need help to finalise an outcome for a claim, contact Local Peer Support (LPS).
9	LPS escalation process If LPS identifies that a claim requires a determination from: Medicare Claims Helpdesk, such as, system abend, file fixes Complete the Medicare Claims File Fix Escalation form and email to Medicare Claims Helpdesk and Support Medicare Claims Helpdesk, such as, complex enquiries, item restrictions, time dependencies Complete the Medicare Claims Enquiry Escalation form and email to Medicare Claims Helpdesk and Support All escalation forms must be sent from MPS Assessing email box. The Resources page contains a link to the escalation forms.