Processing Essential Medical Equipment Payment (EMEP) claims 008-01040030

Processing EMEP claims can occur for the following circumstances:

• a customer has lodged a claim,
• original claim is to be reassessed after a rejection and the customer has:
• provided outstanding requested information, or
• a formal review of decision has been set aside

If a formal review of the decision to Reject EMEP is undertaken, and the decision is changed and details cannot be updated to pay EMEP, the EMEP Override (MEOV) screen can be coded within an EMEP claim to pay EMEP. See Table 3 > Step 2.

Has the customer lodged a Medical Practitioners - Essential Medical Equipment Payment - Medical Confirmation (SA449) form and no claim exists?

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

Medical Report forms are not accepted as a claim for EMEP.

If the equipment user or carer lodges a Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation form (SA449) without a claim, Service Officers must make one attempt to contact the claimant to discuss claiming options and tell them to submit a claim.

If contact is successful:

• Use the EMEP SA449 lodged Fast Note to document relevant details
• Complete any related work items and scanned documents. For further information, see Viewing Centrelink customers' digital images
• Procedure ends here

If contact is unsuccessful:

• Send a Q888 EMEP Request to lodge a claim letter
• Use the EMEP SA449 lodged Fast Note to document relevant details
• Complete any related work items and scanned documents. For more information, see Viewing Centrelink customers digital images

Procedure ends here.

Workload Management allocates EMEP work items to suitably skilled Service Officers.

If a manual search with a Customer Reference Number (CRN) or Claim ID is needed, in Process Direct:

• Select Inbox
• Enter CRN or Claim ID
• Select Go
• EMEP online claim should appear in the Work Items table
• Select the EMEP Work Item

• Select to view the Claim Summary
• Select to expand the Claim Summary
• Review the Claim Summary in a new window if needed. The Claim Summary will show:
• Tasks
• Notes
• Relationship status
• Australian residence
• Select Documents provided by the customer (uploaded online or scanned to their record)
• To view supporting Documents, select:
• links at the bottom of the expanded Claim Summary, or
• select from the bottom of the open Process Direct window, or
• select from the Icon menu
• Check and review all supporting documents are received to process the claim

Claims created as a Social Online Application (SOA) shell will not contain claim details or uploaded data. Details need to be manually updated from the original claim, for example, paper claim.

If no SOA shell exists, create a SOA shell from the Process Direct landing page. See Indexing, re-indexing, and cancelling claim activities.

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

Check the equipment user or carer is currently listed on a Qualifying concession card by checking the Benefit Status.

Is the equipment user or carer concessional?

• Yes, go to Step 6
• No, go to Table 3 > Step 1

Check if EMEP is current using the Medical equipment explanation summary (MEPSUM).

Is EMEP current?

• Yes, go to Step 7
• No, go to Step 10

Review current EMEP details:

• Check if the customer is receiving EMEP for the same residential address
• Check the Medical Equipment Claim Details (MECD) screen to make sure it does not include the same essential medical equipment the customer is already current for
• Check any previous payments of EMEP
• Medical Equipment Energy Proof (MEEP) screen:
• Check for a previous energy account review and if documentation is required
• If required, it must be provided before the EMEP claim can be granted
• Check the equipment user or carer is currently listed on a qualifying concession card
• Future Activity List (FAL) screen for an anniversary date

Where the customer has a change in circumstances, a new claim may not be required. For more information, see Change of circumstances for Essential Medical Equipment Payment (EMEP).

Is there a change in circumstances and a new claim is not required?

• Yes, see Change of circumstances for Essential Medical Equipment Payment (EMEP). Procedure ends here
• No, go to Step 8

Where the EMEP is already current:

• The customer is not required to lodge a new EMEP claim
• Automatic rejection of these claims will not occur if the additional/duplicate claim is lodged after the end of the financial year

Claim submitted in the same financial year:

• will auto-reject PAC if the customer has lodged a claim:
• within 12 months after the previous EMEP, and
• in the same financial year (from 1 July to 30 June)
• can be processed and be auto rejected. See Resources page for eligibility scenarios
• go to Table 3 > Step 1

Claim submitted in a new financial year within 12 months after the previous EMEP, and lodged after end of the financial year in which it was paid:

• Claim must not be processed
• Update the Progress of Claim DOC with relevant details

Contact the customer to explain:

• the EMEP claim they lodged on [lodgement date] cannot be paid
• this is because they already receive this payment every 12 months from their original claim
• their next payment is due on [next payment date]
• they can submit a new claim if they have a change in circumstances. For example, if they use a new item of medical equipment or change address

If contact is:

• Successful:
• Ask the customer to withdraw the claim from their online account
• DOC the record with relevant details
• Unsuccessful:
• Send a Q888 with the approved letter text. See Centrelink letter templates > People with disability > Essential Medical Equipment Payment > EMEP cannot be paid for non eligible claim (Q888)
• Select Status
• Edit > change Status to Withdrawn
• Select Save
• DOC the record with relevant details

Procedure ends here.

Check the claim to make sure all required documents have been provided. If the customer has uploaded a SA440, check that the customer’s declaration (Q45) has been signed.

Has the customer provided all relevant requested documentation and information required for their claim, and are the relevant forms complete?

• Yes, go to Table 2 > Step 1
• No:
• If a request for information has previously been made, the claim will need to be manually rejected Failed to reply to correspondence (FRC), go to Table 2 > Step 1
• For the initial request, go to Step 11

Contact the customer.

If contact is successful, tell the customer:

• What additional information or documentation is required
• To upload evidence through the upload document service:
• Place the claim on hold for one day to allow time for the customer to provide the documentation
• Annotate the Progress of Claim DOC
• Procedure ends here

If contact is unsuccessful:

For both paper and online claims, request the information or medical evidence from the customer (and equipment user if required). This allows the claim to be finalised.

If an incomplete paper claim is received, see Claims received that are incomplete or incorrect.

If the Status of the claim has not automatically updated to On Hold:

• Update the Status of the claim to On Hold and select reason Customer to Provide Information
• On Hold Expiry Date: enter relevant date. See Allow extra time for mail delivery
• Select Save
• Procedure ends here

Note: if medical evidence is provided within 13 weeks of claim rejection date, the original claim can be re indexed and reassessed.

Where the customer is a carer, provisional care receiver details from the claim will show along with care receiver(s) currently linked to the customer’s record.

In Process Direct go to Links Summary (LS) screen will show a Provisional line with the Care receiver details.

Note: for paper claims, a new line will need to be added to the Links Summary (LS) screen before selecting Process.

Is the claim for a Carer?

• Yes, check details are correct and match the claim details. If updates are required:
• Select the Care Receiver
• Check the MEP Care Receiver Details match using the Change Link Summary
• Select SVC Reason: MEP - Essential Medial Equipment Payment
• Select To: MEU - EMEP equipment user
• Start Date will auto populate with the claim start date
• Select Save
• Select Assess, go to Step 2
• No, go to Step 2

Select Process (bottom right of the claim) to start coding and assess the claim.

Do not start coding before selecting Process.

The Errors (SWE) screen will show.

Before coding any screens:

• Select Assess to send the claim details to ISIS
• The Entitlement (ELD) screen will show
• Return to the SWE screen to complete the claim coding by selecting Back or key SWE in Super Key

Message Log

This section will show 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 Selector/s

The Task Selector lists common workflows and screens that can be used during an assessment of a claim. Individual screens or Select all tasks can be selected.

From the Task Selector,

• Select all tasks
• Select Next

Customer Detail Task Selector (CDTS) will present.

Check all relevant screens to compare historical details with the claim details:

• A flag will show against listed screens containing data uploaded from the online claim, ACC or added by a previous Service Officer
• The screens may not need to be checked to process the claim
• Select the relevant screens that need to be checked/updated. There is an option to select all tasks
• Select Next to proceed through selected screens

Note: screens can also be accessed directly through the Super Key.

Update the flagged/selected tasks where applicable:

• Address (AD)
• Check the address details in the claim match the equipment users address
• Select Next
• Payment Destination (PAS) screen
• If payment destination details are already recorded, check they match the claim. If needed, update the PAS details. For more details, see Changing payment destination
• Select Next

Proof of Identity (POI)

On the Proof of Identity Details (POI) screen - check the customer has a confirmed identity status. If the customer’s identity is Not Confirmed, see Table 4 in Alterative Identity.

Select Next.

Check the relevant METS screens to determine if any updates are required:

• Select Medical equipment claim details (MECD)
• Select Action > Edit or ADD
• Select Equipment User
• Enter claim date
• Select Address type - click on search twice
• Select relevant Account type
• Select relevant Energy type
• Select relevant Equipment type, if medically required heating and cooling is the only item being claimed, the medical equipment table must be left empty. The medical condition will still need to be added if not present
• Select Dependant type: Yes/No
• Select Save

Note: if the equipment user does not contribute to the payment of the energy account used to run the essential medical equipment and/or medically required heating/cooling used at the residence, update the MECD screen using the account type CLC-Claimant contributes to payment of account. This is required to manually reject the claim. See Essential Medical Equipment Payment (EMEP) for energy account requirements.

The Medical Equipment User Details (MEUD) screen prepopulates the claim detail information.

Check the Medical Equipment and Medical Conditions match the claim details, make any updates as required.

If the claim is for a carer, Service Officers must switch into the equipment user record:

• Select show / hide relations to view and access equipment users record
• Select equipment user details

In the equipment users record:

• Super key, field, Enter MEUD

If updates are required for the Medical Equipment:

• Select Action > Edit or ADD
• Select Equipment Type
• Select Equipment used: Yes/No
• Select relevant Certificate code list:
• OME - Other medical evidence
• RAP - DVA rehabilitation appliances program
• SAT - State and territory (terr) schemes, rebates and concessions
• TDR - SA449 treating doctor’s report
• Certificate accepted: Yes/No
• Select Save

If the coding on the MEUD screen was completed on the equipment user record due to a carer claim, select show / hide relations to go back to the customer’s record.

Note: if the same piece of equipment is listed on the MEUD screen an error message will present ‘You attempted to create a new record, but no changes made’. Service Officers must delete the Provisional entry added on the MEUD screen.

If updates are required for the Medical Conditions:

• Select action - Edit
• Select the relevant Medical condition causes
• BRI - Brain injury
• CHE - Chronic erythrodermas
• FTH - Full thickness burn
• MDS - Muscular dystrophies
• NDD - Neurodegenerative disorder
• RSD - Rare sweating disorders
• SCI - Spinal cord injury
• STR - Stroke
• Select Equipment used: Yes/No
• Select relevant Certificate code list:
• OME - Other medical evidence
• RAP - DVA rehabilitation appliances program
• SAT - State and terr schemes, rebates and concessions
• TDR - SA449 treating doctor’s report
• Certificate accepted: Yes/No
• Select Save
  

Note: if Medically required heating and cooling is the only item being claimed, an error message may appear on the MEUD screen. Service Officers must remove any details from the Medical Equipment User Details. Update the Medical Conditions if no details are present.

If proof of energy account has been provided select Medical Equipment Energy Proof (MEEP)

• Select Add > Record the evidence for energy proof details provided
• Enter today’s date in Date of Effect
• Select either ACC - Provided and Acceptable or NAC- Provided and not acceptable
• Select Save
• Select Next
• This will remove any future energy account review, or
• Complete any previous review

The Medical Equipment User Qualification (MEMQ) screen - see Change of circumstances for Essential Medical Equipment Payment (EMEP) for instructions on when to code this screen.

The Medical Equipment Payment Explanation Summary (MEPSUM) will show the EMEP Payment explanation summary.

See Table 3.

Once the provisional data has been checked and confirmed:

• Select Assess. Note: do not finalise at this time
• ELD will show the outcome of the claim
• Confirm that the expected outcome is reflected
• Clear any warnings or errors showing on the SWE screen
  Note: when finalising the claim, and the customer is entitled to more than one payment, all are not displayed on ELD screen. If required Service Officers can navigate to the PS to view the full entitlement

Is the correct outcome shown?

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

Take the appropriate action to correct EMEP outcome.

If a formal review of the decision to reject EMEP is set aside and details cannot be updated to grant EMEP, an override will be required. Within the claim activity.

Service Officers must escalate to a Service Support Officer (SSO) for the following steps to be completed. See, Tier 2 technical support - Service Support Officer (SSO).

• Key MEOV - Medical Equipment Payment Override in Next
• Select Add to key the relevant claim details
• Select Assess

If the claim is to be manually rejected on the BA screen:

• Select Add New
• Select Reason > Edit applicable rejection reason
• Date of Effect will prepopulate, or manually update using the claim lodgement date
• Select Save > Assess
• Review the Entitlement (ELD) screen for the correct rejection outcome

Once the claim is assessing correctly, if the customer is not qualified or payable for EMEP:

• Contact the customer before finalising the rejection
• Tell the customer their review and appeal rights

For all claims (both Grant and Reject):

• Once the claim is assessing correctly, select Finish
• The Claim Finalisation DOC will appear, edit or add any extra details if required, see Recording reasons for decisions
• Select Finalise to complete the claim
• If a checklist of scans shows, mark as complete using the tick boxes to close scans off the customer’s record

Note: If the claimant has died since lodging the claim a manual grant or rejection letter must be issued. For the letter template, see People with disability to send the appropriate advice.