Cheque processing in Medicare 011-43090000

• 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.

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. 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:

• the cheque is part of the 90 Day Pay Doctor Cheque Scheme
• the payment will automatically be deposited on the 91st day after the issue date into the eligible health professional's bank account

Procedure ends here.

Do not use modifiers other than DOP/DDMMYY to refine the search as this will remove the CLID line from patient history.

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.

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.

If Medicare Public Telephony Team staff need help to finalise an outcome for a claim, contact Local Peer Support (LPS).

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.

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.

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]

• 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 the Medicare Public Telephony Team
• 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.

Where Medicare Public Telephony Team staff require assistance to finalise an outcome for a claim, contact Local Peer Support (LPS).

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.

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

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.

• 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, escalate the claim to MPS Assessing if the work item is not in PaNDA. If the work item is in PaNDA proficiency raise the claim.

• 8-INCOMP
• I-BEN<CHQ
• 8 BEN<CHQ

• 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]

• 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 must 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. Check amounts before paying the account.

If the repayment benefit amount exceeds the original payment amount or where a warning message (for example, SNET PND) directs to PEND the claim for escalation to MPS Assessing for assessment by experienced staff :

• Select the HOME key and overtype the control line with ‘NPND’ (to pend the claim)
• Complete a customer enquiry form and:
• if not in PaNDA - email MPS Assessing
  The Resources page contains a link to the form
• If in PaNDA - Add a Note to the work item and proficiency raise
• Any ART services (item numbers (13200-13251) are to be pended and if:
• not in PaNDA - email MPS Assessing. The Resources page contains a link to the form
• in PaNDA - Add a Note to the work item and proficiency raise. See Work Optimiser for staff

Procedure ends here.

If Service Officers need help to finalise an outcome for a claim, contact LPS.

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.

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 (SLT).

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

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.

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.

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.

• 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.

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

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].

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.

If the repayment benefit amount exceeds the original payment amount or where a warning message (for example, SNET PND) directs to PEND the claim for escalation to MPS Assessing for assessment by experienced staff.

• Select the HOME key and overtype the control line with ‘NPND’ (to pend the claim)
• Complete a customer enquiry form and email to MPS Assessing for assessment by experienced staff

Any ART services (item numbers (13200-13251) are to be pended and sent to MPS Assessing for assessment by experienced staff.

If experienced staff need help to finalise an outcome for a claim, staff must refer to Local Peer Support (LPS) in the first instance.

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.

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.

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.

• 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.

• Urgent requests can be faxed to the requestor to be resolved
• Non-urgent requests will be forwarded in the internal mail to an identified processing team for action. Any cheques received by this team that cannot be resolved will be forwarded to the requestor

Note:

• all extracted cheques are marked 'VOID' unless otherwise advised
• where a cheque is extracted but does not need to be cancelled, a request must be made not to have the cheque marked
• email the form to Output Management team, Digital Projects Branch
• sent emails are recognised by the agency as a corporate record

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.

If Medicare Public Telephony Team staff need help to finalise an outcome for a claim, contact Local Peer Support (LPS).

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 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

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.

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).

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

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

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

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.

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 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.

If the repayment benefit amount is different to the original payment amount or a warning message (for example, SNET PND) directs to PEND the claim for escalation to MPS Assessing 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
• Complete a customer enquiry form and email to MPS Assessing for claims not located in PaNDA. The Resources page contains a link to the form

Any ART services (item numbers (13200-13251) are to be pended and sent to MPS Assessing for assessment by experienced staff.

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.

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.

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.

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.

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].

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].

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’
  Batch the cheque in the daily work

If experienced staff need help to finalise an outcome for a claim, contact Local Peer Support (LPS).

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.

Is the cheque presented or unpresented?

• presented, go to Step 3
• unpresented, go to Step 2

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
• 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.

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

If experienced staff need help to finalise an outcome for a claim, contact Local Peer Support (LPS).

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.

• 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

• 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

• 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 to the MPS Assessing if the work is not located PaNDA:

• 8-INCOMP
• 1-BEN<CHQ
• 8 BEN<CHQ

If work is in PaNDA, proficiency raise the claim.

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]

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].

• 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

Once cheque is extracted, mark cheque as ‘VOID’ and dispose of in a secure disposal bin to be shredded.

Record a comment in CDMS with action taken.

If working from PaNDA, scan both sides of the ‘VOID’ cheque and attach it to the work item before disposing of, leave a comment with action taken.

Procedure ends here.

If Medicare Public Telephony Team staff need help to finalise an outcome for a claim, contact Local Peer Support (LPS).

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.

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.

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

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

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 Pay Day Doctor Cheque Scheme (Locn Reg for 90d Cheque).

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

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

Tell the claimant because the health professional is part of the 90 Pay Day 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.

When health professional is not registered, the cheque can be stopped or cancelled.

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

Forward all stop cheque and reissue of cheque forms requests to Medicare Public Telephony Team 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.

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.

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

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 to MPS Assessing if the work is not located PaNDA:

• 8-INCOMP
• 1-BEN<CHQ
• 8 BEN<CHQ

If work is in PaNDA, proficiency raise the claim.

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].

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 Medicare Public Telephony Team
• 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

Procedure ends here.

If Medicare Public Telephony Team staff need help to finalise an outcome for a claim, contact Local Peer Support (LPS).

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 Medicare Public Telephony Team email box.

The Resources page contains a link to the escalation forms.