Not effective, rejection or withdrawal of claim for Dad and Partner Pay (DAP) 007-05020050

If:

• the claim is being withdrawn, see Item 2
• the claim lodged is a duplicate claim, see Item 3
• a paper claim is lodged outside of the allowable early claim period, see Item 4
• the claim is to be made not effective, see Table 2
• the claim being rejected, see Table 3

Discuss the reasons for the withdrawal request with the customer and, where appropriate, offer any further referrals or assistance.

Advise the customer that once their claim has been withdrawn, it cannot be reinstated without completing a new claim. To action, see Withdrawal of claims.

Procedure ends here.

If a customer has lodged a pre-birth claim and subsequently lodges another pre-birth claim for the same child:

• Manually update the P1CA screen fields for the duplicate (second claim):
• Action: select NEF (Not effective)
• Reason: select CAM (Claim already made) code
• Effect Date: the date of receipt (DOR) of the claim
• Notes: outline the relevant details
• Finalise the activity on the Entitlement Details (ELD) screen
• Record details in the finalisation Note

Note: there may be duplicate newborn information in the FA081 New born Child Declaration. The FA081 is not a claim and does not need to be made not effective (NEF).

In Customer First, send a manual Q999 letter to the customer advising the outcome. See Resources page for suitable Q999 text.

Procedure ends here.

If the pre-birth claim has been lodged outside the allowable early claim period, the claim will need to be made not effective (NEF).

This will only apply to paper claims, as online claims cannot be submitted if the customer is not expecting a child to come into their care within 97 days.

Processing paper claims in Process Direct where DAP claim lodged outside allowable early claim period:

• When a Social Application (SOA) shell is created in Process Direct, cancel the claim activity. Before cancelling a paper claim activity, the claim will need to be made NEF
• Go to Transaction Summary (TS) screen
• Select Status
• Select Edit
• On the Change Status dialogue box, select Not Effective from the drop down box
• Select Save
• Go to the TS screen
• Check the status of the claim is NEF
• Using the Super Key, go to Activity List (AL) screen
• Select Cancel
• A pop up dialogue box will confirm claim has been cancelled
• Select OK
• If a new claim (NCL) activity SOA shell was not created on the record in Process Direct when a paper claim was scanned, do not create a SOA shell
• In a separate activity in Customer First, update any new details provided in the claim by the customer (for example, telephone number, address, income estimate etc.)
• Record details of the claim outcome on a DOC/Note (e.g. claim outcome is NEF, any other changes to entitlements etc.)
• In Customer First, send a manual Q999 letter to the customer advising the outcome. See Resources page for Q999 text

The customer will be required to complete a new claim within the allowable early claim period to be assessed for payment.

Pre-birth and post-birth DAP claims can be made Not Effective (NEF).

In most cases, the NEF will occur automatically when processing the claim. However, manual coding can be completed in certain circumstances.

Automatic NEF assessments

For DAP pre-birth claims that have been assessed and are awaiting proof of the child’s birth or entry to care, a reminder letter will be sent 21 days after the nominated start date to provide the proof.

If the proof of birth is not provided within 56 days of the nominated start date, the claim will be automatically assessed as NEF.

Manual NEF assessments: To assess whether a manual NEF is required, go to Step 4.

Customer contacts after the claim was made not effective (NEF), check the customer has met all general requirements for an effective claim.

Check the:

• NEF DOC/Note
• Progress DOC/Note
• Customer Letters (HS)

Tell the customer:

• what information is required, and
• their claim can only be assessed from the date all the required information is received

Has the customer provided all the requested information required to make the claim effective?

• Yes, go to Step 5
• No, go to Step 3

Tell the customer what information is required to determine their claim.

If the claim was made online, most of this information would have been mandatory. If further information was required for the online claim, the customer may have already been advised to provide this information on the Next steps page of their online claim.

• Check if the information has already been provided, e.g. via documents in Process Direct or the progress DOC/Notes
• Check if the information has already been requested from the customer, e.g. on the Next steps page of the online claim or in the progress DOC on the customer’s record
• Consider contacting the customer by phone if the information required to finalise the claim can be provided by phone immediately, see Requesting information (CLK)
• Before calling, if the customer is subscribed to Desktop Messaging, send a pre-call notification SMS through Desktop Messaging. For pre-call messages, allow a lead-in time of 5 minutes in case there is a delay sending the message
• If details cannot be provided by phone and/or have not already been requested, send a request for information see Information requests for FTB, PPL and DAP claims, and Add Newborn and PPL change of circumstances activities

Timeframes for return of documents/information

Customers are to provide:

• requested documents/information within 14 days (21 days for remote area or overseas customers)
• Tax File Numbers (TFN) and/or bank account details within 28 days

Allow extra time for mail delivery and for customers to respond.

Has the required information/documentation been received by the resubmit date?

• Yes, go to Step 5
• No, for:
• FCC Processing staff, go to Step 4
• Non-FCC Processing staff, create or record details on a Progress DOC/Notes. Procedure ends here

Generally, the NEF will occur automatically when processing the claim. However, manual coding can be completed in certain circumstances. For example, when information is not provided, it could be appropriate to manually NEF the claim INF (information not provided).

To manually NEF a DAP claim:

• Select the DAP claim
• While processing the claim activity, go to the DAP Claim Action (P1CA) screen
• Manually update the P1CA screen:
• Action: select NEF (not effective)
• Reason: select the appropriate code. See Rejection and not effective codes for Dad and Partner Pay (DAP)
• Effect Date: the date of receipt (DOR) of the pre-birth claim/post-birth claim
• An error message will display if the information in each field does not correspond correctly with the NEF reason.
• Finalise the activity on the ELD screen
• Record details on the Finalisation Note

Apply the most appropriate NEF code to ensure the correct letter is sent to the customer. In very limited circumstances where the manual reason code is OTH, an auto advice will not be sent to the customer. A manual Q999 letter must be issued via Customer First advising their claim is NEF, and the reason. See Resources for Q999 text.

A Social Online Application (SOA) cannot be created for the paper claim if:

• the customer has not provided the requested information (such as nominated start date for their DAP period) within the allowable timeframe, and
• there is not enough information contained in the paper claim to use the SOA

When a SOA cannot be created, the claim activity will need to be made NEF and then cancelled:

• Go to the Transaction Summary (TS) screen
• Select Status
• Select Edit
• In the Change Status dialogue box, select Not Effective from the drop down box
• Select Save
• Go to the TS screen and check the status of the claim is NEF
• Go to the Activity List (AL) screen
• Select Cancel
• Select Ok to confirm cancellation
• If a SOA shell is not created on the record when a paper claim is scanned, do not create a SOA shell
• In a separate activity in Customer First, update any new details provided in the claim by the customer (for example telephone number, address, estimate etc)
• Use Fast Note template in Customer First Families > Claims > Post Birth DAP Not effective /Pre Birth DAP Not Effective to record details of the claim outcome, including any other changes made
• Send a manual Q999 letter to the customer in Customer First advising the outcome. See Resources for suitable Q999 text

The customer must complete a new claim within the allowable early claim period to be assessed for payment.

Procedure ends here.

The date of receipt (DOR) used when re-indexing the claim is the date the requested information was lodged.

If all requested information has been provided:

• Within 45 days of the date the claim was made NEF, and the financial year has not changed since, then the claim can be assessed using the new information and the information from the initial claim
• DOR = the date the new information was provided
• Contact the customer if there are any concerns that their circumstances have changed since the initial claim was submitted
• Within 45 days of the date the claim was made NEF, and the financial year has changed, obtain the relevant financial year income for the new DAP assessment
• After day 45 and in the same financial year in which the initial claim was made NEF
• DOR = the date the new information was provided
• Contact the customer before processing the claim. Check if any details have changed since the claim was submitted
• Before calling, if the customer is subscribed to Desktop Messaging, send a pre-call notification SMS through Desktop Messaging. For pre-call messages, allow a lead-in time of 5 minutes in case there is a delay sending the message
• If the child has been born/entered care, the customer will need to provide all information relevant to make an effective post-birth claim including the child details, birth verification and return to work details
• After day 45 and the financial year has changed, tell the customer they must make a new claim

For:

• Non-FCC Processing staff, go to Step 6
• FCC Processing staff, go to Step 7

• Create a Fast Note. Select Auto text, use Families > Claims > Reassess REJ/NEF – PPL/DAP/FTB. This will be allocated by WLM to an appropriately trained staff member to process
• Procedure ends here

Re-indexing a new claim:

• Go to the Process Direct Landing Page
• Select Inbox
• In the Work Item Search, enter Claim ID in the Main Category and Customer Reference Number (CRN). Select Go
• Select the Claim displayed in the Work Item. Check the claim status is NEF or REJ
• Select > Re Index Claim
• Re-index will generate a new receipt number
• Select and update date of receipt. Select Regenerate Claim. Steps 8 and 9 provide further details about the DOR to use

If all requested information has been provided for a:

• NEF pre-birth claim and the child has not been born/entered into care yet, go to Step 8
• NEF pre-birth claim and the child has now been born/entered into care, and all relevant information has been provided to make an effective post-birth claim, go to Step 9
• NEF post-birth claim, go to Step 9

NEF pre-birth and the child has not been born/entered into care yet

If all the required information has been provided:

• within 45 days of the date the pre-claim was made 'NEF', and the financial year has not been changed since the pre-birth claim can be assessed using the new information and the information from the initial claim
• DOR = the date the new information was provided
• contact the customer if there are any concerns that their circumstances have changed or the financial year has now changed since the claim was submitted
• within 45 days of the date the pre-birth claim was made NEF, and the financial year has changed, get the relevant financial year income for the new DAP assessment
• after day 45 and in the same financial year in which the pre-birth claim was made NEF:
• DOR = the date the new information was provided
• contact the customer before processing the per-birth claim. Check if any details have changed since the claim was submitted
• before calling, if the customer is subscribed to Desktop Messaging, send a pre-call notification SMS through Desktop Messaging. For pre-call messages, allow a lead-in time of 5 minutes in case there is a delay sending the message
• If the child has not yet been born or entered care, contact the customer before processing the claim to confirm the remaining information from the initial claim
• If the child has now been born/entered care, the customer will need to provide all information relevant to make an effective post-birth claim including the child details, birth verification and work details
• after day 45 and the financial year has changed, tell the customer they must make a new claim

Note: if the customer has lodged a subsequent pre-birth claim and the child has not been born yet, this claim can be used to assess DAP for the customer, as all the information should be included in the new claim.

Claim finalisation

See Processing Dad and Partner Pay (DAP) claims.

Procedure ends here.

If the pre-birth claim was NEF and the child has now been born/entered care, the customer will need to make a post birth claim. They will need to provide all relevant information including the child’s details to make an effective post-birth claim. See Processing proof of a child's birth.

If the post birth claim was NEF, the customer will need to provide all the relevant information to make an effective post-birth claim. See Processing proof of a child's birth.

If the financial year has changed since the previous NEF’d claim was lodged, the DAP income test must be assessed based on the new claim date.

If the DAP period has changed, conduct the DAP abridged eligibility test.

The DAP claim can be re-indexed in Process Direct from the date the agency receives the new information.

If all required information has been provided:

• within 45 days of the date the claim was made NEF, the claim can be assessed using the new information and the information provided from the initial claim
• DOR = the date the new information was provided
• Contact the customer if there are any concerns that circumstances have changed since the initial claim was submitted
• between day 46 and within the financial year the claim became NEF, contact the customer before processing the claim.
• Confirm if any of their circumstances have changed since the claim was submitted
• Check if a new financial year income is required
• If required, refer to the abridged eligibility test
• after day 45 and the financial year has changed, tell the customer to make a new claim

A Social Application (SOA) shell Work Item will need to be created.

This contains no claim information apart from the CRN, personal details and the receipt date (date of claim). Manually update the claim information within the Work Item using:

• information from the original claim
• new information, and
• associated documentation

Contact the customer if there are any concerns that their circumstances have changed since the initial claim was submitted.

If the customer is subscribed to Desktop Messaging, send a pre-call notification SMS through Desktop Messaging before calling them. For pre-call messages, allow a lead-in time of 5 minutes in case there is a delay sending the message.

To create a SOA shell:

• Go to Process Direct Landing page and select SOA shell tile
• Enter the Benefit type, CRN and Date of receipt (DOR is the date all the required information was provided)
• Select Create Claim
• An activity with a claim ID will be generated without any claim information.

If the customer has previously provided proof of birth and it is scanned on the record, it can be used for the claim. It can be viewed via Documents in Process Direct.

When the child’s birth verification, including the child’s details, has been provided on the partner’s record, this can be used to assess the customer's post-birth claim.

If the customer has lodged a new online post-birth claim and provided all required information to make the previous post birth claim effecti.ve, the new online claim can be used to assess DAP entitlement for the customer

Claim finalisation

See Processing Dad and Partner Pay (DAP) claims.

Procedure ends here.

Pre-birth and post-birth DAP claims can be rejected. Generally, this will happen automatically based on the customer’s eligibility for payment. However, in some cases a manual rejection may be required.

Check the customer is not eligible for DAP and the reason to reject is correct.

If a manual rejection needs to be recorded:

• Select the DAP claim
• While processing the claim, go to the PPL Claim Action (P1CA) screen
• On the P1CA screen:
• Action: select REJ (reject)
• Reason: select the appropriate manual rejection code
• Effect Date: key the date the rejection is to commence

An error message will display if the information in each field is not consistent with the rejection reason.

Finalise the activity on the Entitlements (ELD) screen.

If the manual rejection code is OTH, the customer must be sent a manual free text (Q999) letter in Customer First advising their claim is rejected and the reason. When creating the Q999:

• Select DAP as the Service Reason
• Select option 1 to include the PPL Act reference. This will ensure the correct 28 day appeal timeframe paragraph is included in the letter

Procedure ends here.

Review the claim details to see why the claim was rejected. Refer to the REJ DOC/Note and/or Customer letters (HS) for the explanation.

Discuss DAP eligibility requirements with the customer. There may be other eligibility requirements that the customer has not met, in addition to the specified rejection reasons. Discuss general eligibility in addition to the specified reason. To be eligible for DAP, the customer must meet the work test, income test, residency requirements, etc.

If the customer is contacting to discuss:

• DAP/REJ-BNR (Birth not registered), see Item 3
• providing supporting evidence to allow the claim to be reassessed, advise the customer about DAP claiming timeframes as well as what evidence is required to reassess the REJ assessment
• not having supporting evidence to allow the claim to be reassessed, advise them about DAP review and appeal rights
• the decision to reject their DAP claim is incorrect, and no additional information is required for their claim to be reassessed, see Item 4
• for a reason not listed above, see Item 4

Customers can request a review and explanation of the rejection by a Subject Matter Expert (SME). If the customer still disagrees with the rejection following the SME explanation and requests a formal review, use the Internal Review/Explanation script to record the customer's application for a formal review.

The customer advises they have registered or applied to register their child’s birth and the birth verification is:

• within 45 days of the date the claim was REJected, and the financial year has not been changed since, then the claim can be assessed using the new information and the information from the initial claim:
• DOR = the date the new information was provided
• Contact the customer if there are any concerns that their circumstances have changed since the initial claim was submitted
• within 45 days of the date the claim was REJected, and the financial year has changed, obtain the relevant financial year income for the new DAP assessment
• after day 45 and in the same financial year in which the initial claim was REJected
• DOR = the date the new information was provided
• Contact the customer before processing the claim. Check if any details have changed since the claim was submitted
• Before calling, if the customer is subscribed to Desktop Messaging, send a pre-call notification SMS through Desktop Messaging. For pre-call messages, allow a lead-in time of 5 minutes in case there is a delay sending the message
• If the child has been born/entered care, the customer will need to provide all information relevant to make an effective post-birth claim including the child details, birth verification and return to work details
• after day 45 and the financial year has changed, tell the customer they must make a new claim

For Non-FCC Processing staff:

• Create a Fast Note. Select Auto text, use Families > Claims >Reassess REJ/NEF-PPL/DAP/FTB claim. This will be allocated by WLM to an appropriately trained staff member to process
• Procedure ends here

For FCC Processing staff:

• Pre-Birth claim lodged: If the customer submitted a pre-birth claim and:
• used the Newborn Child Declaration (FA081) form to provide proof of birth, or
• the claim auto finalised as part of the partners PPL post birth claim and
• the claim has rejected (REJ-BNR) a new claim activity will need to be indexed. This can be done using the Social Online Application (SOA). Use the original claim information provided in the pre-birth claim and post birth claim. Do not re-index the pre-birth online claim as this may result in the incorrect outcome of NEF-POB (proof of birth not provided within 56 days of nominated start date)
• Post birth claims lodged: If the customer submitted a Post-Birth claim only, this can be re-indexed once the customer advises they have registered or applied to register the birth of their child. This can be provided verbally. Note: if a customer is advising after day 45 and the financial year has changed, do not re-index the claim. Tell the customer to make a new claim
• The date of receipt of the claim is the date the customer confirmed they had registered or applied to register the birth of the child. The earliest nominated start date will be the new date of claim or a later date as elected by the customer This can be provided verbally. If the customer notifies:
• within 28 days of the child's date of birth (DOB), the nominated start date may be the child’s DOB or a later date as elected by the customer
• outside 28 days of the child's DOB, the date of receipt is the date they advise they have registered or applied to register the birth of the child

The claim will grant after it has been fully reassessed with the birth registration status updated from No to Yes. In some circumstances the claim may reject for another reason, e.g. customer is working or on paid leave on their DAP period nominated start date (RWP). See Item 4 for Rejection reasons other than BNR.

The customer must register or apply to register the birth of their child before DAP can be granted for the child. If the customer does not understand or does not agree with the decision, and they want to request an explanation or apply for a formal review, see Reviews and appeals of Dad and Partner Pay.

Procedure ends here.

Customers can contact to:

• request an explanation, or
• apply for a formal review of a decision based on eligibility and payability determinations of DAP

Review the record and provide an explanation why the DAP claim was rejected,

Where Service Officers identify an error in the original decision, a reassessment must occur without a request for a formal review of decision.

For the initial DAP claim to be reassessed the customer needs to provide all requested information within 28 days of the rejection. In some circumstances, the customer may require more than 28 days to provide all of the required information, such as evidence from a specialist.

Did the customer provide all of the requested documents/information within 28 days, or a formal review resulted in the DAP rejection decision being set aside?

• Yes, complete a reassessment of the customer’s DAP entitlement. See Item 5
• No:
• tell the customer they can request an explanation or apply for a formal review. See Reviews and appeals for Dad and Partner Pay
• Procedure ends here

Complete a reassessment of the customer’s DAP entitlement:

• Contact the customer if there are concerns or circumstances that have changed since the initial claim was submitted. If the customer is subscribed to Desktop Messaging, send a pre-call notification SMS through Desktop Messaging before calling them. For pre-call messages, allow a lead-in time of 5 minutes in case there is a delay sending the message
• Re-index the claim:
• Pre-Birth claim and child now born - Do not re-index the pre-birth online claim as this may result in the incorrect outcome. If the customer submitted a pre-birth claim and used either the Newborn Child Declaration (FA081) form or the claim auto finalised as part of the partners PPL post birth claim, a new claim activity will need to be indexed. This can be done using the Social Online Application (SOA). Use the original claim information provided in the pre-birth claim and post birth claim. Using the original date of receipt (DOR) of the post birth information
• Pre-Birth claim and child not born yet - If the customer submitted a pre-birth claim and the child is not born yet, the pre-birth online claim can be re-indexed using the original date of receipt (DOR) of the claim
• Post birth claims lodged - If the customer submitted a Post-Birth claim only, this can be re-indexed using the original date of receipt (DOR) of the claim

For Non-FCC Processing staff:

• Create a Fast Note. Select Auto text, use Families > Claims > Reassess REJ/NEF – PPL/DAP/FTB. This will be allocated by WLM to an appropriately trained staff member to process
• Procedure ends here

For FCC Processing staff:

• Go to the Process Direct Landing Page
• Select Inbox
• In the Work Item Search, enter Claim ID in the Main Category and Customer Reference Number (CRN). Select Go
• Select the Claim displayed in the Work Item
• Select > Re Index Claim
• Re-index will generate a new receipt number
• Select and update date of receipt. Select Regenerate Claim

See Processing Dad and Partner Pay (DAP) claims.

Birth mothers are not eligible to claim DAP. Customers must have one of the following relationships with the child to be eligible for DAP:

• biological father
• partner of the birth mother
• adopting parent
• partner of the adopting parent
• parent in a surrogacy arrangement
• partner of a parent in a surrogacy arrangement, or
• partner of the biological father (not the birth mother)

DAP claims must be lodged by the father of the child or partner of the birth mother. Claims lodged by the birth mother will be made not effective, as they are not an eligible person to claim DAP.

The customer must be advised why the claim is not effective and advised that a new claim needs to be submitted by the father of the child or partner of the birth mother.

The claim will automatically be made not effective (NEF) if the customer has selected 'None of the Above' as their relationship to child. If the customer incorrectly selects another relationship to child type, that is, partner of birth mother instead of the birth mother, follow the relevant steps below.

Within the pre-birth or post-birth claim activity, update the relationship to child in the PPL Claim Details (P1CLM) screen to 'None of the Above':

• Select Edit
• Update Relationship to child as None of the Above
• Select Save

Process and finalise the claim following normal procedures. Check the ELD screen is displaying DAP/NEF-IDR (Not an Eligible Carer/Parent) before finalising the claim.

A claim lodged in this way is to be made not effective (NEF).

If it is identified that a claim has been lodged using another person’s online account, phone the customer to discuss the online services conditions of use. See the Resources page for a link to the conditions of use.

If appropriate, register the correct customer for Centrelink self-service during this contact.

Smart Centre Processing

For an authenticated claim:

• Go to the Transaction Summary (TS) screen
• Select Status
• Select Edit
• On Change Status, select Not Effective from the drop down box
• Select Save
• Go to the TS screen and check the status of the claim is NEF
• Go to the Activity List (AL) screen and cancel the claim activity
• Select Cancel. A dialogue box will confirm claim has been cancelled
• Select Ok
• Record a Note on the incorrect record with claim details
• Index another claim on the correct record in Process Direct via a Social Application (SOA) shell
• Go to Process Direct Landing Page
• Select SOA shell tile
• Select Benefit Type
• Enter Customer CRN and Date of Receipt
• Select Create Claim
• A claim ID will be generated and go to the Claim Details
• Finalise the claim 'NEF' on the correct record (as shown above), as Services Australia does not have the correct digital signature for this claim to be effective
• The person whose name is on the claim must lodge an additional claim using their online account
• If required, refer the record to the DQU (NA8) Intertwined Team for follow-up. The Resources page contains a link to Office Locator for contact details and the Intertwined Referral form

For an unauthenticated claim:

• Cancel the MFU activity on the incorrect record and record a Note with the claim details for storage
• Index the claim on the correct record in Process Direct via a SOA shell:
• Go to Process Direct Landing Page
• Select SOA shell tile
• Select Benefit Type
• Enter Customer CRN and Date of Receipt
• Select Create Claim
• A claim ID will be generated and go to the Claim Details
• Finalise the claim 'NEF' on the correct record (as shown above), as the agency does not have the correct digital signature for this claim to be effective
• The person whose name is on the claim must lodge an additional claim using their online account
• Refer the record to the DQU (NA8) Intertwined Team for follow-up. The Resources page contains a link to Office Locator for contact details and the Intertwined Referral form

For help with viewing and initial processing of submitted online claims, see Online or Assisted Customer Claim (ACC) for family assistance, Parental Leave Pay (PPL) and Dad and Partner Pay (DAP).

Issue a Free Text (Q999) letter in Customer First to the customer detailing the reason for the claim being made 'NEF' and their review and appeal rights.

See the Resources page for approved sample letter text.