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Amend a customer's Medicare enrolment details 011-44110000

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This page has details on the action required when a customer has been incorrectly enrolled in the Medicare program.

On this page:

Incorrectly enrolled

Acceptable documents for incorrectly recorded date of birth

Amend incorrectly recorded date of birth

Amending an incorrect date of birth when error message 12300 is showing


Incorrectly enrolled

Table 1

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StepAction

1

Customer is present in a Medicare service centre

If an ineligible customer has been enrolled in Medicare and the customer is present in a Medicare service centre:

  • explain there has been an error in their enrolment and they are ineligible to remain enrolled in Medicare
  • consumer end date the customer's enrolment and include message in the CDMS Personal Comments field

2

Details given by another customer

If an ineligible customer has been enrolled in Medicare and the details have been given by another customer (in person, over the phone or in correspondence), further investigation is necessary:

  • recall documents from archives (if applicable)
  • write to the customer informing them it is necessary to confirm their Medicare eligibility
  • add a comment in the CDMS Personal Comments tab about what detail was received and that an incorrect enrolment letter has been sent

Note: it is important to remember that details about a suspected incorrect enrolment cannot be disclosed to anyone other than the customer concerned. This is especially important when alerted to an incorrect enrolment by a member of the public.

For more details, see Escalation process for Medicare Eligibility and Child Dental Benefits Schedule (CDBS).


Acceptable documents for incorrectly recorded date of birth

Table 2

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StepAction

1

Acceptable documents where a customer's date of birth is incorrectly recorded

When a customer contacts for a change to date of birth incorrectly recorded, the following documents are acceptable:

  • Australian birth certificate
  • Australian Drivers licence
  • Australian Passport
  • Australian Certificate of name change
  • Australian Citizenship Certificate
  • Immicard
  • Certificate of Identity
  • Foreign passport with current Australian visa

See Table 3.


Amend incorrectly recorded date of birth

Table 3

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StepAction

1

Request to update incorrectly recorded date of birth

2

Request by phone

The caller must be the customer who is changing their date of birth.

Complete customer authentication, see Authenticating a Medicare customer.

Has the customer passed authentication?

  • Yes, go to Step 3
  • No, request they email or mail supporting documents. Procedure ends here

3

Customer consent

Read the following to the customer:

'Do you understand that identification documents you give to Services Australia will be checked with the issuing authority to confirm validity. The documents are subject to agency compliance and audit processes. In providing these documents, you consent to the agency validating the documents with the issuing authority.'

Has verbal consent been given?

  • Yes, go to Step 5
  • No, add comments in CDMS Personal Comments tab - verbal consent not obtained, document not verified through DVS. Procedure ends here

4

Verbal consent

Attempt to contact the customer.

If successful contact:

'Do you understand that identification documents you give to Services Australia will be checked with the issuing authority to confirm validity. The documents are subject to agency compliance and audit processes. In providing these documents, you consent to the agency validating the documents with the issuing authority.'

  • Has verbal consent been given?
    • Yes, go to Step 5
    • No, add comments in CDMS Personal Comments tab - verbal consent not obtained, document not verified through DVS. Procedure ends here

If unsuccessful contact

5

Access the Medicare DVS Portal

Does the service officer have access to the Medicare DVS Portal?

HSDD:

  • Yes, use the Medicare DVS Portal and attempt to verify documents
  • No, contact a Team Leader

Face to face:

Is verification successful?

6

Log in to CDMS

On the CDMS Home page:

  • select Amend Consumer Details
  • key the customer's Medicare card number in ID Number field
  • select Personal

7

Change customers date of birth

In Consumers, select the radio button against the customer to be changed.

In Personal Details, amend the customer's details, as required:

  • date of birth, or
  • Birth Date Accuracy field, select a value to indicate the accuracy of the date of birth

Does the error message 12300 DATE OF BIRTH>MEDICARE ENTITLEMENT START DATE show?

  • Yes, go to Table 4 and follow the process
  • No, make any other amendments in the remaining fields, as needed. Select:
    • Validate
    • Validate
    • Update to confirm all details
    • A Medicare Payment Integrity (MPI) restriction may be present stopping amendment. If this occurs contact Medicare and Aged Care - Local Peer Support (LPS)

8

Record comments

If DVS has been used, record comments in CDMS Personal Comments tab.

Request received by phone:

  • DVS consent acquired (insert date). (Insert document type and document reference text/document number), VRN: (insert VRN number). For example:
    • PaNDA work item ID: 1235467891. DVS consent acquired 10/12/2020. Marriage certificate, reference number 256256/2014, VRN: 12345
  • Scroll down and select Validate
  • Action any warning messages and Validate
  • If the details are correct, select Update

If DVS has not been used (change made in a service centre), record comments in CDMS Personal Comments tab.

Record the document reference text/document number. For example, Marriage certificate, reference number 256256/2014.

Procedure ends here.

9

Document verification unsuccessful

Was LPS document verification successful?

10

Contact customer

Was customer contact successful?

  • Yes, customer gives other identification document. Go to Step 5
  • No, customer contact is unsuccessful and/or second attempt at verification fails

Amending an incorrect date of birth when error message 12300 is showing

Table 4

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StepAction

1

Enter the customer's Medicare number in Amend Consumer Details on CDMS

Select the Personal tab and select the radio button of the customer requiring the date of birth correction (only applicable if more than one customer on the Medicare record).

Select Entitlement tab and take note of the Entitlement Type and Date:

  • Select the relevant Eligibility Status radio button and select Amend
  • Select Documents tab to confirm if any identity documents have already been recorded

2

Eligibility documents

Have eligibility documents been previously recorded?

3

No document recorded
  • Select Document of Identity from the Eligibility Document dropdown menu
  • In the Reference Text field, enter in 'DOB OB Work Around' and any other reference related to the document given
  • in the Reference Date field, enter the customer's correct date of birth
  • Select Validate
  • Select OK when the message 00634 appear
  • Select Return
  • Select Validate
  • Select Update on the Confirm Amended Medicare Entitlement Details
  • Select OK if the message 00144 appears
  • Select OK when the message 00454 appears

4

Deleting current Entitlement Type

Make sure to take note of the Entitlement Type before deleting.

Note: if the customer has an existing Closing The Gap (CTG) registration, take note of the start date before deleting the entitlement. Deleting the entitlement removes the CTG start date from CDMS.

  • Under the Eligibility Status field select the radio button with the Entitlement Start Date to be deleted
  • Select Delete
  • Select No when the message 00633 appears
  • Select OK when the message 00646 appears
  • Select Validate and Update
  • Select OK when the message 00144 appears
  • Select OK when the message 00454 appears

If error 16034 appears:

  • Code 01/07/2021 in the CTG start date
  • Select Validate - Validate
  • Update
  • Continue

If error 16030 appears:

  • Code the relevant start date in the CTG start date
  • Select Validate - Validate
  • Update
  • Continue

5

Amending the date of birth
  • Select the Personal tab on the bottom of the screen
  • Amend the customer's date of birth to their correct date of birth
  • Select the Date is valid (not estimated) from the Birth Date Accuracy dropdown menu
  • Select Validate
  • If the error message 00395 appears because the Indigenous status has not previously been recorded:
    • Select OK
    • Select the correct status from the Aboriginal/Torres Strait Islander/South Sea Islander dropdown menu
    • If status is not known, select Not Applicable from the dropdown menu
    • Select Validate
  • Select OK when the message 00645 appears
    • Select Validate and Update
  • Select OK when the message 00359 appears
  • If error message 12302 appears
    • Select OK
    • Click on the Documents button
    • A warning Message 00661 appears
    • Select OK
    • Select Validate

Note: if My Health Registration message is returned - select NO (unless request for a My Health Registration has been given).

6

Re-entering Entitlement type details

Select the Entitlement tab.

Re-enter the Entitlement Type, Country of Relevance and Entitlement Start Date.

The Entitlement Start Date is the customer's date of birth or relevant start date (if customer is eligible after their date of birth):

  • Select relevant entitlement from the Eligibility Type dropdown menu
  • Select country from the Country of Relevance dropdown menu
  • key the Entitlement Start Date, this is the customer's date of birth or relevant start date (if customer is eligible after their date of birth)
  • Select Validate
  • Select OK when the message 00645 appears
  • Select Validate and Update
  • Select OK when the message 00144 appears
  • Select OK when the message 00454 appears

Note: if no identity document was given, and DOB OB workaround from the Document of Identity dropdown menu as part of this work around, it must be deleted.

Was DOB OB workaround keyed as identity documents?

7

Deleting DOB OB workaround documents
  • Select the Documents tab
  • Select the documents to be deleted (Ref text will read - DOB OB WORK AROUND) and select Delete
  • Select NO when warning message 00183 appears
  • Select OK when message 00644 appears
  • Select Return, Validate and Update
  • Select OK when message 00454 appears

8

Check how many members are on the Medicare record

Is there only 1 member on the Medicare record?

9

Confirm Group Eligibility Start Date

If the customer is the only member on the Medicare record, amend the Group Eligibility Start Date to the customer's date of birth (or other relevant start date if eligible after their date of birth).

Note: this date should only be amended if the customer is the only member on the Medicare record.

  • Select the Group tab
  • Select Card Request
  • Amend the Group Eligibility Start Date to either the customer's date of birth (or other relevant start date if eligible after their date of birth)
  • Select Validate
  • Select OK when the message 00645 appears
  • Select Validate and Update
  • Select OK when the message 00105 appears

10

If help is needed to finalise the transaction

See Escalation process for Medicare Eligibility and Child Dental Benefits Schedule (CDBS).