Complex Assessment Officers (CAO) 101-05070000

CAO assessment can be requested for:

• new claims processed using Process Direct and non-new claim referrals in Process Direct via Referrals
• other claims and non-new claim referrals in Customer First using CAO Referral guided procedure
• escalations via CAO Fast Note

For instructions on CAO referrals and escalations, see Identifying and making suitable referrals to the CAO.

Financial hardship

If financial hardship criteria are met, an escalation can be sent after a CAO referral has been made.

Asset hardship

For reassessments of a payment under the asset hardship provisions, see Assessment of assets hardship. Contact must be made with the Assets Hardship team before making a CAO referral.

CAO work items are allocated via 'ready for work' in either Customer First, Work Optimiser or Process Direct.

To view details of the referral for:

• New claim referrals created in Process Direct:
• Open Customer First
• Key in the CRN > [Enter]
• Select the CRN/BP hyperlink
• Select the Activities tab
• Locate the CAO referral work item and select the referral ID hyperlink
• Select the Notes tab
• Select the Text hyperlink to view all notes
• Non-new claim referrals created in Process Direct:
• Open Process Direct and select Customer Summary
• Key the CRN and select Go or [Enter]
• Select the customer’s name to display the record
• Select the Transactions icon > All transactions
• Select the referral identification number link for CAO referral in the list
• When the Referral landing page screen shows, select Next at the bottom of the screen to view the notes on the CAO Referral page
• Referrals created in Customer First:
• View Notes on the DL screen in Customer First

Escalations via Fast Note are to be closed after an existing work item, or a new work item (activity or DOC) has been created or allocated to the CAO.

Is the CAO referral for a valid CAO assessment reason and needs a CAO assessment?

• Yes, go to Step 3
• No, go to Step 10

Only one CAO referral is required including for partnered customers.

Check Work Optimiser for duplicate referrals

• Select ‘Worklist’
• Change ‘My Work’ to ‘Customer Search’
• Enter Customers CRN into ‘Customer ID’

Is there a duplicate CAO referral in Work Optimiser?

• Yes, duplicate referrals to be cancelled or closed before continuing, see Table 2, Duplicate CAO referrals to action
• No, go to Step 4

Was the CAO assessment requested for a new claim and the new claim has since been withdrawn or rejected?

Note: this does not apply where the new claims process was selected in a referral for current customers with new trust/company involvement or LIC renewal.

• Yes, go to Step 10
• No, go to Step 5

Has all the information and documents needed to complete the CAO assessment been provided?

• Yes, go to Step 11
• No, go to Step 6

If scanned documents are indicated in the referral, wait until they are available before calling the customer. If not available within 2 working days, attempt to contact the customer by phone and clarify what has been lodged. Send a pre-call notification SMS if the customer is subscribed to electronic messaging. See Calling a customer or returning a customer’s call.

Could the customer be contacted?

• Yes, go to Step 7
• No, go to Step 8

• Confirm the referral reason and documentation requirements
• If additional supporting documents are needed, request information and documents
• Get third party contact details and authority to contact third party as needed. If necessary, ask the customer to tell the third party we may contact
• Tell the customer:
• the due date for the return of information and documents
• their claim will be rejected if not provided by the due date
• if a letter will be sent to formally request the additional documents
• Annotate the Progress of claim Note/DOC or the CAO referral DOC to record the phone conversation

The customer must be told if additional information or documents are needed. This includes when a third party (for example, accountant) has been contacted for information and/or documents.

Request further information/documents from the customer using the most appropriate channel. See Requesting information (CLK):

• Verbal request
• Issuing Request for Information (RFI) guided procedure
• QSS32 or XOBS32 (customers outside Australia) letter

Note: for Aged Care Means Test assessments use the templates located on the Resources page of Aged care letters - creating manual letters.

Where a customer has requested the CAO obtain documents through a third party, the CAO should issue a Q999 to the third party in addition to the request for information letter sent to the customer.

Document the record with details of the request i.e. annotate the Progress of claim Note/DOC or CAO referral DOC with details of the request. For example:

• Verbal request for information
• Request for information sent, asking for…
• Customer advised accountant's details as...
• Unable to contact customer (include phone number(s), date and time(s) of contact attempts)

Place the activity on hold and allow extra time for mail delivery.

Have all the information and documents needed to complete the CAO assessment been provided?

• Yes, go to Step 11
• No, record on a Note/DOC that the CAO is unable to make an assessment because the customer has not provided the requested information. Include details of the outstanding information, go to Step 10

A CAO assessment is not to be completed where:

• a new claim has been withdrawn or rejected
• the request does not meet the CAO assessment guidelines

A CAO assessment is unable to be completed as:

• insufficient details have been provided to complete the assessment, and
• the customer fails to respond to a request for information

If a CAO is unable to complete the CAO assessment:

• document the reason the assessment could not be completed, including details if due to outstanding information
• the 'subject line' for the CAO DOC must be CAO Assessment, so it is easy for processing staff to identify
• finalise the CAO Assessment DOC by selecting Completed
• close CAO referral

Note: updating the status to Completed will complete the referral task and it will no longer be available for further action.

Process Direct:

• Edit the Referral Details assignment block to update the status to Completed
• Select Save to finalise the changes

Customer First:

• Finalise the CAO referral activity by selecting from the Activity List (AL) screen and completing the started DOC
• if inappropriate CAO referrals have been received, when it is appropriate to provide feedback, use designated Staff Feedback channels

Is there a claim/activity related to the referral on record (Customer First, Customer Record or Process Direct)?

• Yes, go to Step 13
• No, go to Step 14

Before completing assessment

Decide if the CAO assessment will be the major factor in any adverse decision that affects the customer's payment. If it is, the CAO is to tell the customer by phone (2 attempts). See Advising verbally of an unfavourable decision.

CAO to complete the CAO assessment, then go to Step 12.

• DOC the CAO decision and include the action required by the Service Officer
• The 'subject line' for the CAO DOC must be CAO Assessment so it is easy for processing staff to identify
• Finalise the CAO Assessment DOC by selecting Completed
• Close CAO referral:

Process Direct:

• Edit the Referral Details assignment block to update the status to Completed
• Select Save to finalise the changes

Customer First:

• Finalise the CAO referral activity by selecting from the Activity List (AL) screen and completing the started DOC

Note: if a process requires a specific work allocation action, follow the instructions provided

Is there a claim/activity related to the referral on record (Customer First, Customer Record or Process Direct)?

• Yes, go to Step 13
• No, go to Step 14

In Process Direct:

When the referral work item is set to Completed, the claim status should automatically change from On Hold to In Process where there are no other referrals with a Status of In Process.

Confirm the status in:

• Process Direct > Select Status
• If the claim status does not automatically change in Process Direct, check if there are any other referrals still In Process. If there are none, update the Status to In Process.

In Customer First or Customer Record

• For activities (including claims), manually take the associated activity off hold on the Activity List (AL) screen
• If the customer's partner also has a claim held for the same referral reason, make sure the partner's claim Status is no longer On Hold

Note: taking the activity off hold will result in it being allocated, based on previously established priorities. The user logon on this activity does not impact work allocation.

Procedure ends here.

More action is required for the following:

If more action is needed and no activity about the referral is on record (Customer First, Customer Record or Process Direct), create an open work item:

• Use Fast Note - select Auto Text using either:
• Complex Assessment > New Claim > CAO requests SO action for New Claim
• Complex Assessment > UPD > CAO requests SO action for Reassessment
• Insert date CAO assessment completed and claim type or service reason
• Select Confirm
• Add keyword to the activity for claim type/service reason
• ACTABY - ABSTUDY
• ACTAGE - Age Pension
• ACTAUS – Austudy/Youth Allowance (Student)
• ACTCAR - Carer Payment
• ACTDSP – Disability Support Pension
• ACTFHA - Farm Household Allowance
• ACTJSP - JobSeeker
• ACTLIC - Low Income Health Care Card
• ACTPPP - Parenting Payment Partnered
• ACTPPS- Parenting Payment Single
• ACTRCA - Aged care means assessment
• ACTSPB - Special Benefit
• ACTYAL - Youth Allowance (JobSeeker)

Note: the claim type/service reason keyword must be added at the time the Fast Note hand off is created. If this is not done, an Unfinalised Activity - Immediate Action required work item will appear in the Inbox. If this happens, complete the original Fast Note, then re-create the hand-off in line with the process above.

Procedure ends here.

Place a Display on Access (DOA) DOC on the record if the customer was receiving income support payment or a Low Income Health Care Card:

• granted before a CAO assessment, and
• has since been cancelled, and
• has not provided the documents needed, and
• all reasonable attempts have been made to contact the ex-recipient to request the information needed

Use Fast Note > Complex Assessment > New Claim > CAO Assessment unable to be completed:

• DOA Code: NSE Non-standard earning assessment
• Expiry Date: leave blank
• Transfer to Region: CAO
• Keywords: CAOCAN
• Extra Details: CAO Assessment Incomplete
• Complex Assessment Officer (CAO) assessment unable to be completed for (PAYMENT TYPE) claim period xx/xx/xxxx – xx/xx/xxxx
• Payments cancelled before CAO assessment and customer failed to reply to CAO request for information
• If the customer claims an income support payment or a Low Income Health Care Card, continue new claim process including any required CAO referrals as per business as usual requirements
• Do not close the DOA DOC until the action needed for past claim period has been determined
• Procedure ends here

Forward the CRN by email to Business Process CAO, where:

• the customer claims an income support payment or a Low Income Health Care Card
• an annual review is due for the DOA DOC

Business Process will escalate reported cases to the payments type programme team.

• If more than one CAO referral has been created:
• copy the referral description notes of the most recent referral, including the date and time. Annotate the oldest referral with the details
• cancel or close the most recent referral, ensure the oldest referral remains open
• If the customers activity (including new claims) status is set as “Open” place the activity On Hold for 42 days whilst the CAO assessment is pending
• If the CAO referrals were generated on the same date in Process Direct and another system, keep the Process Direct referral
• To see where the referral was made, check the Work Item ID in Work Optimiser:
• Work items created in Process Direct start with a zero '0'
• Work items created in Customer First/Customer Record start with the Customer Reference Number (CRN)

Is a duplicate referral created in Process Direct being closed?

• Yes, go to Step 2
• No, cancel the duplicate referral from the Activity List (AL) screen in Customer First/Customer record. Procedure ends here

Remove the CAO referral via Customer First:

• select the CRN/BP hyperlink next to the customer's CRN
• select the Activities tab to show outstanding activities
• locate the CAO Work Item and select the blue Work Item ID to open the work item
• select Edit
• select the status drop down box and select Not required
• select Save
• If the customers activity (including new claims) status is set as “Open” place the activity On Hold for 42 days whilst the CAO assessment is pending
• Procedure ends here