Ex-Carer Allowance (child) Health Care Card (EHC) 101-06030000

Does the customer have a disability or medical condition that previously qualified their carer for a Carer Allowance (CA) (child) Health Care Card for the customer on the day before the child turned 16?

• Yes, if the customer is:
• aged 15 and 9 months to 25 years, go to Step 2
• not between these ages, check eligibility for Low Income Health Care Card (LIC) or a Centrelink payment. Procedure ends here
• No, check eligibility for LIC or a Centrelink payment. Procedure ends here

Note: customers can lodge completed claims up to 3 months before turning 16 years old.

Has the customer stopped full time study?

• Yes, see Changes in a customer’s circumstances and effect on concession card entitlement. Procedure ends here
• No:
• and has provided a SS456 or SS490 form at a service centre, go to Step 3
• otherwise, go to Step 4

When a SS456 or SS490 form is presented at a service centre:

• check the application is fully complete:
• each question has been answered
• the claim form has been signed
• the checklist has been completed (see back of claim form)
• relevant documents have been supplied at each section where requested. Paperclip icons displaying on claim forms indicate evidence is needed
• tell the customer or correspondence nominee of the next steps for claim assessment
• scan the claim and supporting documents
• key any identity confirmation documents if applicable
• discuss the security benefits of Voice Biometrics and encourage the customer to enrol

Will the SS456 or SS490 form be processed at point of contact?

• Yes, go to Step 4
• No:
• tell the customer the claim form will be scanned onto the record and sent for processing
• procedure ends here

Locate the work item in Process Direct.

Select the Work item to go to the Customer and Claim Information table on the Transaction Summary (TS) screen to review and process the customer’s claim.

Paper claims

When a claim for Ex-Carer Allowance (Child) Health Care Card (SS456) is scanned to the customer's record, a Social Application (SOA) shell work item is generated on the customer's record. This contains no claim information apart from:

• the Customer Reference Number (CRN)
• personal detail, and
• receipt date

Claim information will need to be manually added into the work item using details from the scanned claim and documentation.

To access claims for processing, see Process Direct navigation, common screens and functions.

Has the claim previously been rejected?

• Yes, to reassess a previously rejected claim:
• if rejected FRC, see Request to reassess a rejected claim
• to re-index the claim, see directions for SAP online claims in Indexing, re-indexing and cancelling claim activities. Once claim is re-indexed, go to Step 6
• No, go to Step 6

The customer:

• has lodged an EHC claim or renewal, go to Step 8
• is wanting to renew EHC outside of 13 weeks of expiry, go to Step 7
• is EHC current and wanting to verbally renew or has lodged a paper form within 13 weeks of expiry, see Step 1 in Table 3

If the customer is contacting outside 13 weeks of the expiry date the customer must re-apply for the card.

• tell the customer to lodge an online claim, or
• run an Assisted Customer Claim (ACC), see Viewing and processing online and Assisted Customer Claim (ACC), or
• run the First Contact Service Offer (FCSO) workflow. This will issue a customised Claim for Ex-Carer Allowance (child) Health Care Card (SS490), or
• issue an Application for a Health Care Card for a former recipient of a Carer Allowance Health Care Card (SS456)

Procedure ends here

Select:

• to review the claim contents
• to expand the Claim Summary in a new window if needed

Review the Claim Summary. Key details, include:

• relationship status
• Australian residence
• income details

Select Documents to view the documents provided by the customer (uploaded online or scanned to their record).

To view supporting documents, select one of the following:

• links at the bottom of the expanded Claim Summary
• from the bottom of the open Process Direct window, or
• the Documents icon

Note: it is not mandatory for the customer to supply their student identification (ID) number

Have all relevant supporting documents been provided?

• Yes, go to Step 11
• No, go to Step 9

A customer identified as vulnerable as part of the EHC online claim can submit their claim before completing all required tasks.

Does the claim have the keyword ‘URGVULN’ on the Keyword screen?

• Yes, and:
• only additional documents are now required, go to Step 10
• it has been less than the time allowed to respond since the claim lodgement, hold the claim for the appropriate timeframe from the Claim Submission Date on the Status screen. On the Notes screen add or update the Claim Progress Note with action taken. Procedure ends here
• it has been more than the time allowed to respond since claim lodgement, the claim must be rejected. REJ the claim FSD (Failure to Supply Documents). Procedure ends here
• No:
• if additional documents are required, go to Step 10
• if documents have been requested at the time of claim or after and not returned, the claim must be rejected. Procedure ends here.

If more details or clarification of the claim and/or submitted documents are needed to determine the customer’s eligibility, make genuine attempts to contact the customer.

If contact was successful, record the details of the conversation in the Progress of claim Note. If the customer:

• provided required all information to assess the claim verbally and/or the customer can immediately upload the information, go to Step 11
• cannot immediately upload the information and it is still required:
• issue a request for any additional information. Select > Request Documents
• do not re-request documents that have previously been requested at the Next Step of the claim
• tell the customer the claim may be rejected if they do not provide the required evidence. The claim will be placed on hold to allow customer to respond. Procedure ends here

If the contact was unsuccessful or it is not appropriate for the customer to provide the information or evidence verbally:

• issue a request for information. Select > Request Documents
• record the details of the genuine attempts, including what information is needed in the Progress of Claim note. Note: documents that have been requested at Next Step in the claim must not be requested again, the claim must be rejected
• procedure ends here.

These details must be reviewed/updated before selecting Process.

Relationship details are viewed on the Transaction Summary (TS) screen:

• Link Summary (LS) table shows linked records, for example:
• Partner and any Relationship Qualifier Code
• Children
• Marital Status (MS) table shows the customer’s relationship details

For help with coding, see Process Direct navigation, common screens and functions

Where updates have been made to relationship details, the claim will need to be regenerated:

• select > Regenerate claim to regenerate the claim

See Step 1 in Table 2.

Select Process. Do not start coding before selecting Process. This will result in errors.

The Errors (SWE) screen will display.

Before coding any screens:

• select Assess to send the claim details to ISIS
• the Entitlement (ELD) screen will display
• return to the SWE screen to complete the claim coding. Select Back or key ‘SWE’ in Super Key

Message Log

This section displays any errors with existing coding. These must be fixed before the claim can be assessed. For help, see Using Digital Assistant Roxy in Process Direct.

Task Selectors

These list common screens. Task selectors that contain mandatory screens are pre-selected.

Task selectors may not list all screens that need to be checked or coded. Check screens to compare historical details with the claim details.

A flag displays against all listed screens that contain provisional claim data. These may not need to be accessed to process the claim:

• select the screens to be checked and/or updated. There is an option to select all screens
• select Next or press [Enter] to go through the selected screens
• use Super Key to go to screens. Key 'screens' to view a full list

Has the customer provided all required information?

• Yes:
• and the customer has asked for the start date of the EHC to be backdated, go to Step 2
• otherwise, go to Step 4
• No, streamline reject the claim as FSD - failed to supply documents. Procedure ends here.

If the customer wants to backdate the EHC entitlement start date to a date earlier than the default start date, they must:

• provide evidence of a medical service or treatment received by the care receiver on a relevant date
• provide evidence the care receiver has been a full time student for the entire period from the relevant start date, and
• satisfy all qualification criteria for the entire period from the relevant date

Has the customer provided evidence and requested the start date to be backdated?

• Yes. If the claim is to be backdated:
• less than 40 weeks from processing date, go to Step 3
• more than 40 weeks from processing date, refer to the Level 2 Policy Help Desk - Concessions to request a manual override. Go to Step 4 once response from Level 2 Policy has been provided
• No, the claim cannot be backdated, go to Step 4

To backdate the start date for EHC, the Date of Receipt (DOR) for the claim activity must equal the date of medical service or treatment and must not be more than 40 weeks earlier than today’s date.

Where the decision to backdate the customer’s claim has been made, update the claim status, as a new SOA Shell will need to be created:

• select the Status icon
• select the Change Status icon
• update the Status field to Not Required
• select Save

Create a SOA shell with the DOR equal to the date of medical service or treatment. This cannot be more than 40 weeks before today’s date.

Select Process. Do not start coding before selecting Process. This will result in errors.

Record the backdated grant date on the Ex-Carer Allowance (Child) Health Care Card Assessment (EHCA) screen:

• select Add
• in these fields:
• Date of event, key the backdated date
• Ex-CA (child) status, prepopulated
• Full time student, select Yes or No
• Student Number, optional
• select Save

Update the LIC Start Date (LSD) screen:

• select Add
• in these fields:
• Start date, key the backdated date
• Reason for backdating, key valid reason
• select Assess
• when the Entitlement Results (ELD) screen displays, manually navigate to all relevant screens. Ensure all Event Date field entries align with the backdated start date recorded on the LSD screen
• select Save

Select all relevant Task Selectors and select Next:

• update required information for each relevant screen
• check information provided in the claim (provisional data) is accurate and in line with any evidence that has been provided. Update where necessary
• check there is no conflict between the provisional data and confirmed data. Correct where necessary
• check nominee information has not been incorrectly ended. For example, Public Trust nominees
• go to the Ex-Carer Allowance (Child) Health Care Card Assessment (EHCA) screen ensuring the relevant start date has been coded

After coding the claim and addressing the data validations:

• select Assess
• the Errors (SWE) screen will list any validation errors to address
• once the Message Log is clear, select Assess
• the Entitlement (ELD) screen displays the outcome. Ensure the outcome is correct for the customer (and partner if applicable)
• select Finish
• review the Claim Outcome DOC. Ensure the text, Act reference and date are correct and meet the Getting it Right (GIR) Minimum Standards
• select Finalise
• select Finish. A box will confirm the claim has been successfully completed

Claims processed before the customer turns 16 years of age will issue a card on the 16^th birthday if all other requirements are met.

Procedure ends here.

The customer will automatically be issued a renewal advice, advising to contact to renew their EHC card. This will create a Future Activity List (FAL) activity.

If the customer does not respond within 28 days their card will expire and their record status will be CAN-EXP.

If EHC has expired there will be no FAL activity to complete.

If the customer:

• has lodged a paper claim form, go to Step 2
• is contacting to verbally renew their EHC and their card:
• is current, go to Step 3
• has expired and it is within 13 weeks of the expiry date, go to Step 4

The customer has submitted a new claim to renew their EHC card, tell the customer the claim will be processed to issue a new card.

Scan the form and any supporting documents onto the customers record, see Scanning Centrelink documents using an MFD

Tell the customer the claim will be sent for processing.

Procedure ends here

In Customer First, select ISS from the System field, key ‘SVEHC’ in the Next field and press [Enter].

Select the renewal activity either from the FAL or Activity List (AL) screen and select the screens that need updating.

To convert activity from FAL to AL:

• go to FAL
• select the Ex-Care Receiver Health Care Card/Renewal activity
• select To SELECT future activity for update
• Source and Date of Receipt will prepopulate, select Continue

From AL or once activity is converted from FAL to AL:

• go to the Ex-CA (Child) HCC Assessment (EHCA) screen, all details will prepopulate. Only update if Student ID has changed with:
• Date of Event as contact date
• Action, key 'I' (Insert) or 'C' (Change)
• select Continue
• on the Assessment Result (AR) screen, select Finalise
• record details using Fast Note - select Auto text > Concession Cards > Claims > Ex-CDA (child) HCC (EHC) NCL Grant/Reject option

If the customer has also submitted an EHC new claim, update the claim status to Completed. Go to Step 5

Procedure ends here

In Customer First, select ISS from the System field, key SVEHC in the Next field and press [Enter].

Create an activity on the Benefit Action (BA) screen:

• in these fields:
• Service Reason, key EHC - Ex CA Child HCC
• Action, REN (renewal)
• Effect Date, key previous card cancellation date
• Source, update with applicable
• Receipt Date, key processing or claim submission date, select Submit Change twice
• on the Ex-CA (Child) HCC Assessment (EHCA) screen, all details will prepopulate. Only update if Student ID has changed with:
• Date of Event as contact date
• Action, key 'I' (Insert) or 'C' (Change)
• select Continue
• on Assessment Result (AR) screen, select Finalise
• record details using Fast Note - select Auto text > Concession Cards > Claims > Ex-CDA (child) HCC (EHC) NCL Grant/Reject option

If the customer has also submitted an EHC new claim, update the claim status to Completed. Go to Step 5

Procedure ends here

Go to Process Direct to finalise the EHC SOA:

• select Inbox tile
• key the Customer’s CRN, select Go
• select the Ex-Carer Allowance (child) Health Care Card Work Item, with the corresponding Claim ID
• select the Status icon
• select the Change Status icon
• update the Status field to Completed
• select Save