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

Item

Description

1

Equipment user submits a duplicate EMEP on either side of the financial year

Fred lodges the first claim for EMEP on 10 June 2023. Services Australia grants the claim for 2 items of medical equipment.

The anniversary date is set as 10 June 2024. The 12 months from the grant date of this original claim.

While EMEP is current (CUR), the payment will:

• automatically issue for the 2 items of equipment in 12 months on 10 June 2021 (anniversary date), and
• continue to automatically pay every 12 months on 10 June until Fred loses qualification. Fred does not need to reclaim each year

Fred lodges another claim for EMEP on 3 July 2020, however:

• there are no change in circumstances, and
• the claim lists the same 2 items of medical equipment

• Cancel the new claim activity as Fred is already current with a valid anniversary date and is claiming for the same 2 items of essential medical equipment.

2

Equipment user submits more than one duplicate claim across the end of the financial year

Joan lodges a claim for EMEP on 3 Sept 2023. Services Australia grants the claim for 2 items of medical equipment as Joan is eligible.

The anniversary date is set as 3 Sep 2024 and 12 monthly ongoing.

As EMEP is current, Joan’s EMEP will:

• automatically issue payment for the 2 items of equipment on the 12 month anniversary date, 3 Sep 2024
• continue to automatically pay every 12 months on the anniversary date (until Joan loses qualification)

Joan lodges a second claim for EMEP on 10 Oct 2023:

• there is no change in circumstances, and
• the claim lists the same 2 items of medical equipment

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)

Joan’s claim is processed and automatically rejected for reason ‘PAC’ as there has been no change in circumstances and the system recognises payment has already been made for the same circumstances in the current ‘financial year.’

Joan waits until till the end of the financial year and claims a third time on the 8 August 2024, before the anniversary date of 3 Sep 2024:

• there is no change in circumstances, and
• the claim lists the same 2 items of medical equipment

Cancel the new claim activity as Joan is already current with a valid anniversary date and is claiming for the same 2 items of essential medical equipment. Joan has now tried to submit 3 duplicate claims for EMEP in the space of 11 months and did not have a change of circumstances or claim for new essential medical equipment.

3

Customer claims EMEP as equipment user and is rejected No Medical Evidence NMN

George submits a claim for EMEP.

George does not provide confirmation from a Treating Health Professional (THP) that they are required to use a nebuliser daily. A request for information is issued and the claim is held for 21 days.

The review date is due and the customer has not responded, the EMEP claim is rejected for reason No Medical Evidence (NMN) as George has not provided the required information.

George receives correspondence that the EMEP claim has been rejected and contacts within 13 weeks of the rejection notice being issued. A Service Officer explains that George was required to provide confirmation of the condition from the THP. George provides this information within 13 weeks of the decision to reject the claim. George’s original EMEP claim is then re-assessed for their qualification to EMEP.

Note: EMEP claims may be reassessed where all outstanding requested documents have been provided within 13 weeks of the rejection notice being issued.