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 MEP/NCL activity 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, genuine attempts to contact the claimant, must be made 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 work items through Work Optimiser or a manual search via Inbox in Customer First.

EMEP claims are processed in Customer First. Key SVMEP in the Next field and select ISS System.

Access the Staff Process Claim Workflow through Workspace>Claim Contacts>Online and families claims. On the Claims Overview page:

• Check for status Indexed:
• Claims to be reassessed may have a status of Dataload Completed
• Select the Claim ID field to navigate to the Claim Detail page

A scanned EMEP paper claim creates a claim activity on the Activity List (AL) screen.

Go to Document Tools, select View to review the scanned claim (SA440/SA451):

• customers may lodge multiple claims using the SA451, for multiple equipment users living at the same address
• consider whether medical evidence has been lodged separately to the claim form to determine the date of claim

Review the Claim Detail and information provided by the customer:

• Online claims, select Review Claim to review the claim details
• Claim forms review details in the scanned claim form
  Note: if a paper claim is incomplete, take appropriate action to obtain the missing information for the claim, see Claims received that are incomplete or incorrect.
• Select Document Tools to view documents provided by the customer
• To view supporting Documents:
• Go to Document Tools
• Select View
• Review all relevant documents

Note: a completed Essential Medical Equipment Payment Equipment User Declaration (SA450) form is required for all paper claims made by a carer where the equipment user has not signed the Equipment User Declaration on paper claim.

If payment destination details are already recorded, check they match the claim. If needed, update the PAS details.

• Key PAS in Next
• Go to the Payment Destination (PAD) screen and enter account details
• Select [Enter]

For more information see Changing payment destination

Check the customer has a confirmed identity status in the Identity Confirmation Dashboard in Process Direct, see Identity Confirmation.

The equipment user meets their identity requirements when one of the following applies:

• Has or achieves a confirmed identity status, or
• Is receiving a social security pension, social security benefit and there is a Legacy POI Tier 2 or 3 recorded on the POIS screen
  Note: for a carer claim, check/code identity for the equipment user on the equipment user’s record. See Identity Confirmation

Does the equipment user meet their EMEP identity requirements?

• Yes, go to Step 7
• No, see Alternative Identity Resources page and follow the instructions in the EMEP task card

Check if EMEP is current using the Workspace > Payments & Services > Medical equipment explanation summary (MEPSUM).

Is EMEP current?

• Yes, go to Step 8
• No, go to Step 11

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 ensure 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
• Workspace > Concession Cards > Concession card details:
• 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 9

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.

• For duplicate claim submitted in the same financial year, EMEP claims 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)

These claims can be processed and be auto rejected. See Resources for eligibility scenarios. Go to Table 3 > Step 1

• For duplicate 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 must not be processed:
• cancel the EMEP claim activity
• Use the Progress of claim Fast Note to record a Progress of Claim DOC
• Add Keyword 'EMEPOC'. The keyword must be added to allow future tracking of cancelled claims
• Close the DOC

Make a genuine attempt to 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. To locate the approved text, go to:
• Letters and electronic messaging > Centrelink > People with a disability > Essential Medical Equipment Payment > Q888 letter - EMEP cannot be paid for non eligible claim
• DOC the record with relevant details

Note: cancelling the EMEP new claim activity (not the EMEP payment) will not cancel the online claim. The online claim will remain unprocessed unless the customer cancels or withdraws the claim. Legacy online claims can only be withdrawn if the claim is no more than 14 days old.

Procedure ends here.

Paper claim details need to be entered manually.

It may be necessary to index or re-index the claim, go to Table 2 > Step 2

Access the Staff Process Claim Workflow through Workspace>Claim Contacts>Online and families claims. On the Claims Overview page under Other Channels:

• Check for Status Digitised
• Select the claim Activity ID:
• Claims already streamed may have a status of Dataload Started
• In Claim Detail:
• Select Enter Claim Data
• On the Make a Claim page, record answers to questions per claim details
• Review your Claim Answers
• If details need to be corrected, select the question set from the specific menu to update
• Once the claim questions have been answered and all details are correct the Data Entry Complete page displays

Check all required documentation or information has been received.

Note: if customer has selected MRHC in the online claim but has not provided the medical evidence, a SA449 will need to be provided.

Has the customer provided all relevant documentation and information required for their claim?

• Yes, select Continue to process claim. See Table 2 > Step 1
• No, if a request for information has previously been made, the claim will need to be rejected:
• Select Continue to process claim
• see Table 2 > Step 1
• No, for the initial request:
• Select Save and Exit
• Go to Step 12

Make genuine attempts to 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
• 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) to allow the claim to be finalised:

• Place then claim on hold, see Allow extra time for mail delivery
• Procedure ends here

The EMEP claim status must display as Indexed.

Is the claim status Indexed?

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

It may be necessary to index or re-index a paper claim.

Access the Staff Process Claim Workflow through Workspace>Claim Contacts>Online and families claims. On the Claims Overview page under Other Channels:

• Select the Claim ID:
• Claims to be reassessed may have a Status of Dataload Completed
• Select Index the claim or Re-index this claim

When Index the claim or Re-index this claim is not presenting, manual action is required:

• Cancel any registered MEP NCL activity on the Activity List (AL) screen (if required)
• On the Claims Overview page under New Essential Medical Equipment Payment Claims > Start a New Essential Medical Equipment Payment claim:
• Select Paper Claim from the drop-down box
• Select New EMEP Claim
• On the Make a claim page, enter claim information
• In Claim Detail:
• Select Enter Claim Data
• On the Make a Claim page, record answers to questions per claim information
• Once the claim questions have been answered:
• Review claim details
• If details need to be corrected, select the question set from the specific menu to update
• When all details are correct the Data Entry Complete page displays:
• Select Continue to process claim

In the Staff Process Claim > Claim detail:

• Select Process this claim
• The Preparing for Claim processing page will display potential obstacles on the record:
• Clear any activities that may prevent claim processing
• Select Continue
• On the Process Online Claim processing page select Continue

Is the claim for a carer?

• Yes, go to Step 4
• No, go to Step 5

Where the customer is a carer the Compare Care Receiver details page presents. Provisional care receiver details from the claim are displayed along with care receiver(s) currently linked to the customer's record.

If the status is Action Required:

• Select the care receiver hyperlink

On the MEP Care receiver details page:

• Select the matching care receiver from the customer's record
• Select Continue
• Select Accept this record, or
• Select Create a new link to the care receiver record
• Select Continue
• On the Search for MEM Care receiver record page:
• Confirm correct existing person or child record after thorough search
• If record is not found:
• Select Create a new MEP Care Receiver. See Searching for a customer on the system
• Ensure all details are correct on the Creating a MEP Care receiver record page
• Select Create and Link this record
• Alternatively, select Do not link this care receiver, and follow up manually after this workflow to complete the link outside the claim
• Select Continue

Was care receiver linked successfully?

• Yes, go to Step 5
• No, manually code the link as follows:
• Select the NCL activity from the AL screen
• Go to the LS screen
• In the link type, key MEP to bring up the provisional link
• Select the provisional link
• Press [Enter] to bring up the customer search
• Key the details of the record being linked. If the link is to a child, change record type from PER to CHI
• Select the person and press [Enter]
• 'Y' to confirm
• Reselect claim via the Staff Process Claim workflow
• Select Continue
• Go to Step 5

On the EMEP Verification Documents screen record:

• Medical Equipment Details for each item of equipment. Select applicable box:
• document type or specific evidence provided, and/or
• Not Provided or Unacceptable
• Where the Treating Health Professional (THP) has not completed the Essential Medical Equipment Payment – medical confirmation (SA449) form or eligible medical evidence to verify equipment is being used:
• Select Not Provided or Unacceptable
• Claim will reject NMN – No Medical Evidence
• Equipment User declaration (SA450) (if required). If the user declaration has not been provided:
• Select document type
• Select Not Provided or Unacceptable
• Medically Required Heating/Cooling for the care receiver screen (if relevant). Select applicable box(s):
• The document (SA449)
• Not Provided or Unacceptable, and/or
• Medical condition(s) verified

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

When all evidence has been recorded:

• Select Continue
• On the Commence data load page, select Send data now
• Select Ok on Data Load Completed pop up

Review information on the Results of Claim Processing screen and take appropriate action:

• Select Workspace or Home
• Select Activity List (AL)
• Select the EMEP claim activity
• Select Continue

Check/update EMEP information on the following screens:

• Medical Equipment Task Selector (METS):
• Select MEUS/MECD/MEUD and MEEP
• Select Continue
• Medical Equipment User Selection (MEUS):
• prepopulates self or equipment user, or
• Select Add new equipment user
• Search equipment user and select correct record
• Select Continue
• For equipment user claims:
• Medical Equipment User Details (MEUD):
• prepopulates the claim information
• Update if required
• For carer claims, in the equipment user's record:
• Medical Equipment User Details (MEUD):
• add relevant information from the claim
• Select the EMEP/add activity from their AL screen
• Select Continue
• Finalise the activity
• Return to the customer record to continue EMEP claim
• Select claim from AL
• Select Continue
• Medical Equipment Task Selector (METS):
• Select MEUS/MECD and MEEP
• Select Continue
• Medical Equipment Claim Details (MECD):
• prepopulates the claim information
• Update if required
• Select Continue
• Medical Equipment Energy Proof Details (MEEP):
• Record the evidence of energy account provided
• Enter today’s date in Date of Effect
• Select ‘Provided And Acceptable’ for Energy proof provided
• Select Update
• Select Continue
• This will remove any future energy account review, or
• Complete any previous review
• When evidence was requested and has not been provided:
• Do not select yes for MHRC, select no, wait for medical evidence to confirm the need for heating and cooling
• Leave medical conditions Blank in data entry/load paper claim
• Select Continue
• Claim will need to be manually rejected failed to reply to correspondence (FRC)
• When evidence has not been requested or provided:
• Leave Blank
• Select Continue

Check any warnings and clear any errors on the Assessment Warning and Error (AWE) screen:

• AWE will present E257U - No POI for customer error:
• Select Continue
• Key POI in Next

Does Identity Confirmed or Current Customer – POI already established display?

• Yes,
• Key AR in Next, select Continue
• See Table 3 > Step 1
• No, see Alternative Identity and follow the instructions in the EMEP task card

Check outcome of claim is correct on AR screen.

Is the correct outcome displaying?

• Yes, go to Step 3
• No:
• Select Do not Finalise
• Select Continue
• 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:

• Key MEOV - Medical Equipment Payment Override in NXT
• Select the relevant claim details
• Select Continue

If the claim is to be rejected for failed to reply to correspondence (FRC):

Key BA – Benefit action in Next

• Code the relevant fields:
• Svc Rsn - 'MEP'
• Action - 'REJ'
• Reason – Select applicable rejection reason
• Effect Date – will prepopulate, or use claim lodgement date
• Select Submit Change
• Key AR in Next
• Select Submit Change

Is the correct outcome displaying?

• Yes, go to Step 3
• No, check if the customer is in a valid residence to determine the coding requirements, then:
• Select the Equipment User Manual Qualification (MEMQ) in Next
• Key claim receipt date in Date of effect
• Select applicable Eligible outcome (Yes or No)
• If No is selected, select applicable reason. For example, if they are in hospital or in prison
• Select Update
• Select Continue
• Go to Step 3

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

• Make genuine attempts to contact the customer before finalising the rejection
• Tell the customer their review and appeal rights

For all claims (both Grant and Reject):

• Select Finalise
• Record details on a DOC using the Fast Note – EMEP > EMEP claim > EMEP Claim Grant For more information, see Recording reasons for decisions under Getting it Right (GIR)
• Complete any related work items and scanned documents. For more information see Viewing Centrelink customers' digital images
• An automatic advice will be issued to the customer with the claim result:
• 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

Note: if the claim is to be rejected failed to reply to correspondence (FRC), list all documents not provided at the time of the rejection in the Fast Note DOC.

If the claim is to be rejected for no medical evidence (NMN), the Fast Note DOC must be updated listing documents not provided at the time of the rejection.