Medicare eligibility quality checking processing 111-22090030

Service Officers must log into Medicare Mainframe (CICS).

Key 'QBBI' and press [Enter].

The QBBI screen shows:

• details of selected transactions from the previous day's processing, and
• any outstanding transactions not actioned

CDMS transactions selected for quality checking show in the QCS using the legacy (CICS) transaction IDs. The following relationships with the legacy transaction ID and the Medicare eligibility processing activities show:

• EANU (E2) - register Medicare card details
• EREU (E1) - amend Medicare card details
• EFPU (E3) - amend personal details
• ELNU (E6) - amend Medicare entitlement details
• ERFU - amend Program Review details

To select the transaction to quality check:

• Place the cursor in the 'S' (select) field, and
• Press [Enter]
• The customer's mainframe enrolment screen shows
• Press [F3] to return to the QBBI screen

Quality checkers must check the transaction against the supporting source documents, which may be located in:

• PaNDA (Scanned documents)
• Customer First (Medicare Newborn Manual Enrolment (MAENROL))
• Service Officers batch (F2F processing)
• MEE portal (Digital Medicare Enrolment and Extension)

Note: source documents may not be available for CDMS updates that have resulted from a verbal request.

• Before checking the enrolment, search for all possible customer records:
• Highlight and copy the Medicare card number from the QCS
• Go to CDMS and paste the Medicare card number into the Inquire on Consumer Details search screen, then select Entitlement
• The Entitlement Details Inquiry screen for all members associated with the Medicare card number displays

After checking Medicare details on the Entitlement Details Inquiry screen, do a consumer search to make sure no duplicate records have been created. Complete a Mandatory detailed search in CDMS.

Compare the source documents with details in the CDMS history using the CDMS quality control quick reference guide.

If more than one consumer ID needs checking, select the radio button for each individual.

When updates are completed in CDMS as a result from a verbal request, quality check to be completed according to the relevant business rules.

See Resources for link to CDMS reference guide.

After examining the transaction and source documents, return to the QCS.

QCS shows b (browse) in the S field and is now ready to accept status codes in the STATUS field to indicate whether or not the transaction had been processed correctly or incorrectly. See Resources for status codes.

In the STATUS fields for the transaction selected, key one status code and press [Enter], (this should be the error with the greatest impact).

QCS returns a lower case u in the S field to advise that the selection has been updated with an error status code.

If several updates have been done in CDMS on the same Medicare card, QCS may select the same card multiple times on the same day. In these cases, quality checkers must only action the first transaction line related to the same Medicare number with a valid status code. Leave additional duplicate transaction lines unactioned. They will automatically be removed from QBBI after 21 days.

After actioning all the appropriate transactions, press [PF3] to exit QCS.

Each time a quality check is completed, the quality checker must:

• email the Service Officer and their Team Leader advising the quality check outcome
• use the relevant QBBI quality checking email template for sending emails, see Resources for template

For identified errors the quality checker must:

• for QBBI - only record the error that is deemed to have the greatest impact
• submit the Medicare Error Explanation form, making sure to record all errors identified. See Resources for link. This data assists stakeholders to analyse issues identified while quality checking
• complete the MHR Registration email template and send to Digital Health Support if a My Health Record error is identified. See Resources for the template
• give feedback with a brief description of the action required by the Service Officer for correction

Manual - (completed by Face to Face Service Officers only)

Endorse the source documents and batch envelope with:

• QC
• Quality checker's signature
• Date

Do not write on the front of source documents. This helps to make sure details do not get covered which allows for reviewing in the future if required.