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

For initial action if an EMEP claim or related supporting documentation has been submitted, see Claiming Essential Medical Equipment Payment (EMEP).

In Customer First, check the following screens before starting the claim:

• Workspace > Payments & Services > Medical equipment explanation summary:
• 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
• a new claim is not required if the same customer has already been approved for EMEP in the past 12 months for the same residential address and the same essential medical equipment
• Workspace > Concession Cards > Concession card details:
• to be eligible for EMEP, the person with medical needs (equipment user) must hold or be listed on a qualifying concession card
• Future Activity List (FAL) screen for an anniversary date

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 person/carer or nominee must be made to discuss claiming options.

Contact customer to tell the equipment user or carer to submit an online 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

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 EMEP already current with a set anniversary date?

• Yes, go to Step 4
• No, go to Step 6

Check the claim for any change in circumstances. For example:

• new essential medical equipment and/or medically required heating/cooling
• if the customer has now lost qualification

Is there a change in circumstances?

• Yes, go to Step 6
• No, go to Step 5

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. These claims must not be processed or paid.

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 the Resources page for eligibility scenarios.

Duplicate claim submitted in the new financial year

Action the following for claims lodged:

• within 12 months after the previous EMEP, and
• lodged after the end of the financial year
• cancel the EMEP claim activity (not the EMEP payment itself)
• DOC the record with 'EMEP claim lodged on [insert date] has been cancelled/not processed. This is because the claim is not eligible as there is no change in circumstances/qualifying event. EMEP will automatically pay on anniversary date [insert DD-MM-YYYY]'
• before closing the DOC, add Keyword 'EMEPOC'. The keyword must be added to allow future tracking of cancelled claims

Make one attempt only 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
• 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

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.

If the customer is unable or unsuitable to complete an online claim, they can lodge a paper claim for EMEP using:

• Claim for Essential Medical Equipment Payment (SA440), and
• Claim for Essential Medical Equipment Payment - Multiple Claim (SA451)

Both forms are available on the Services Australia website.

Has a paper claim for SA440 and/or SA451 been lodged?

• Yes, go to Step 7
• No, go to Step 9

The EMEP system can only be accessed within Customer First. To access the EMEP system to process EMEP claims, in the System field, select ISS then in the Next field, key SVMEP.

An indexed MEP NCL activity should display on the Activity List (AL) screen as a result of scanning of the SA440/SA451.

Check the Document List (DL) screen for progress DOC.

Go to Document tools to view the scanned image of the SA440/SA451.

If the customer advises of a change in circumstances (such as a change of address), this update must be completed outside the claim. Contact the customer by phone to confirm the start date for the new address and update.

Before processing the new claim, check the MECD screen to make sure that it does not include the same essential medical equipment the customer is already current for. This will reduce the risk of an overpayment:

• 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 before determining the date of claim

Run the Staff Process Claim workflow.

On the Claims Overview page, select the Claim ID field for the current claim (created via scanning of the SA440/SA451) to go to the Claim Detail page.

It may be necessary to index or re-index the claim:

• cancel the registered MEP NCL activity on the Activity List (AL) screen and/or start a New EMEP Claim on the Claims Overview page using the dropdown box
• on the Confirm claim page, indicate whether the person claiming is the person with medical needs or their carer

Check Date of Receipt and Source fields and correct if necessary:

• on the Claim Details page, begin data entry by selecting the Enter Claim Data button
• select SA440 Data Entry Flow and record answers to all questions per claim information provided by the customer. The questions are the same as in the online claim flow
• the Data Entry Complete page will display when all questions have been answered

If all details are correct, select Continue to process claim button.

If details need to be corrected, select the question set from the menu and update details.

Go to Step 10.

The EMEP system can only be accessed within Customer First. To access the EMEP system to process EMEP claims, in the System field, select ISS then in the Next field, key SVMEP.

Daily processing includes searching for submitted online claim activities.

Run the Staff Process Claim workflow in the customer's record.

On the Claims Overview page, select the Claim ID field for the current claim to go to the Claim Detail page.

Check the status of the claim. Index the claim if it was not automatically indexed.

Select the Process this claim button.

The Preparing for Claim processing page will display potential obstacles on the record, and any documents requested from the customer online.

Expand the twisty Supplementary information on the Claim detail page to view additional documents requested.

Check conflicting information with What you must do page.

If the customer has claimed EMEP as a carer, the Compare Care Receiver details page displays care receiver details from the online or paper claim and details for any carer 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
• create a new link to the care receiver:
• confirm correct existing person or child record after thorough search, or
• if record is not found, create a new care receiver record

Was care receiver linked successfully within the Staff Process Claim workflow?

• Yes, go to Step 11
• No, manually code the link as follows:
• select the NCL activity from the AL screen in Customer First
• 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

Once completed, reselect the claim via the Staff Process Claim workflow.

On the EMEP Verification Documents page, record:

• Medical Equipment Details for each item of equipment EMEP being claimed for. Indicate:
• the type of document provided confirms the person uses the equipment in their home
• no evidence has been provided, or
• the document is not acceptable
• if the doctor has written on the SA449 form without ticking a box, or has provided a letter that does not clearly state the customer/care receiver is using the equipment:
• go to the Medical Equipment User Details (MEUD) screen
• select the box 'SA449 treating doctor report'
• select 'No' for Certificate accepted
• this will reject the claim with reason NMN - No Medical Evidence
• do not reject the claim, go to Table 2, Step 3
• User declaration (paper claims only):
• if the customer has claimed EMEP as a Carer and the equipment user has not provided a declaration that they have given their consent to the EMEP being claimed, select from the dropdown box
• for online claims, the declaration (SA450) will be requested in a post-payment review
• Medically Required Heating/Cooling for the care receiver page (if relevant). Indicate:
• verification provided (Medical confirmation (SA449) or other acceptable medical certification must be provided). At least one of the specified medical conditions listed in Q4 of the SA449 must be ticked at Q4 or written at Q6 on the SA449. must be ticked at Q4 or written at Q6 on the SA449
• medical condition(s) verified
• if no condition is selected at Q4 of the SA449, and the condition provided at Q6 of the SA449 is not an eligible condition for EMEP to be paid for medically required heating/cooling, staff must reject the claim VME - No valid medical equipment. See, Table 2, Step 5

For help, see Eligibility for EMEP.

On the Claim Summary page, review the information.

To upload claim data into the EMEP new claim activity, select the Process this claim button.

The Claim processing results page displays any further action and any manual coding/action required before the claim can be finalised.

Exit workflow.

Use the Progress of EMEP claim Fast Note to record a Progress of Claim DOC.

Select MEP/NCL activity from Activity List (AL) page.

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

The equipment user meets their EMEP 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 or ABSTUDY Living Allowance payment and with 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 2
• No, see Alternative Identity, Resources page and follow the instructions in the EMEP task card

Check the Medical Equipment Energy Proof (MEEP) page to see if the customer needs to provide energy account review documentation. If so, energy account review documentation must be provided before the EMEP claim can be granted.

If energy account evidence supporting the claim has been provided with the customer's initial claim, update the MEEP screen to exclude the customer from an energy account review.

If the customer has been selected for an energy account review and evidence is unacceptable or was not provided, request evidence, along with any other documentation for the energy account.

Has all required medical information/documentation been provided to finalise the claim (including identity documents and energy account, if required)?

• Yes, go to Step 4
• No, go to Step 3

Request the information or medical evidence from the customer and equipment user if required to allow the claim to be finalised.

For both paper and online claims, issue an RFI and hold the claim until the expiry of the extra time allowed for mail delivery plus one day.

If, within the allowable timeframe, documents/information:

• are received, go to Step 4
• are not received, process claim and reject EMEP

Note: if the rejection reason code of FRC is used, create a Decision DOC and include a list all documents not provided at the time of the rejection.

If the EMEP claim is rejected for the reason of NMN, the Decision DOC must be updated listing documents not provided at the time of the rejection.

EMEP claims may be reassessed where all outstanding requested documents have been provided within 13 weeks of the rejection notice. See the Resources page of Customer initiated review of decision for date of effect examples.

Go to Step 6.

Select MEP NCL activity from AL page.

To check/update EMEP information:

• on the Medical Equipment Task Selector (METS) page, select pages required
• on the Medical Equipment User Selection (MEUS) page, select the user or add an equipment user
• the Medical Equipment Claim Details (MECD) page can be used to view previous claim details or update current claim details (claim date, address type, energy account details, medical equipment for which EMEP is being claimed)
• for carer claims:
• update the Medical Equipment User Details (MEUD) screen in the equipment user's record
• select the EMEP/add activity from their AL screen
• finalise the activity, and
• return to the customer record to finalise the EMEP claim
• the MEUD page can be used to:
• add essential medical equipment
• add medical condition if an EMEP is being claimed for medically required heating/cooling
• indicate that equipment is being used or not
• indicate that a care receiver has withdrawn their consent or to change the non-consent reason
• correct medical verification details
• update the MEEP page if an energy account was provided, as required for an energy account review

Has the customer only claimed EMEP for medically required heating/cooling and no eligible condition has been listed, or referenced, on the SA449?

• Yes, and:
• an online claim was lodged, manually select the claim activity from the Activity List (AL). Update the Medical Equipment User Details (MEUD) to remove MHC from Add equipment/Medical condition type by changing selection to Select An Option. Go to Step 6
• a paper claim was lodged, manually select the claim. Select the claim activity from the Activity List (AL), leave the Medical Equipment User Details (MEUD) screen blank. Go to Step 6
• No, process the EMEP claim, go to Step 6

If the payment is not showing on the Payment Destination Summary (PAS) screen:

• from the PAS screen, go to the Payment Destination (PAD) screen and enter account details
• press [Enter]

The PAS screen will display and account details should now show for EMEP.

Go to the Assessment Results (AR) page and check the result.

Are EMEP eligibility requirements met?

• Yes, grant EMEP(s). If necessary, qualification for an equipment user can be manually set to 'ON' on the Equipment User Manual Qualification (MEMQ) page
• Finalise the claim
• Record details on a DOC using the Fast Note – EMEP > EMEP Claim > EMEP Claim Grant
• No, reject EMEP(s) and check that the reason is correct. If necessary:
• the claim can be manually rejected by coding the correct rejection code on the Benefit (BA) screen
• qualification for an equipment user can be manually set to 'OFF' on the MEMQ page. For example, if they are in hospital or in prison
• finalise the claim
• record details on a DOC using the Fast Note – EMEP > EMEP Claim > EMEP Claim Rejected

Note: if the rejection reason code of FRC is used, list all documents not provided at the time of the rejection in the Fast Note DOC.

If the EMEP claim is rejected for the reason of NMN, the Fast Note DOC must be updated listing documents not provided at the time of the rejection.

An automatic letter will be sent to the customer to advise the result of their claim. If the claimant has died since lodging the claim a manual grant or rejection letter must be issued.

Formal review of decision

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) page can be coded within an MEP/NCL activity to pay EMEP.