Provider Registration quality checking in QST 111-22160000

The Provider Registration quality checking process aligns Services Australia's Enterprise Quality Framework and the 7 quality principles.

The quality checking process:

• helps Team Leaders and Quality Checkers identify process improvements
• ensures consistency in quality checking

This procedure will guide staff to complete quality checking for the Provider Registration program.

Out of scope

The following work types are not captured within these procedures:

• Location-Specific Practice Number (LSPN)
• Pathology
• Sonographers
• Specialist Recognition (SRAC)

The Service Delivery Support team is responsible for:

• analysing national quality reports to identify learning needs or process improvement opportunities
• escalating national quality issues to the relevant program or policy area and/or to the Quality, Performance & Technical Support team
• reviewing and updating the relevant Operational Blueprint files and training materials
• reviewing suggestions and working collaboratively with the Quality, Performance & Technical Support team to improve Operational Blueprint quality checking process and resources
• identifying strategic and operational risks or issues that impact customer outcomes

Managers/Team Leaders are responsible for ensuring:

• Quality checkers complete the process for Quality Checker Accreditation
• Quality checkers hold appropriate skill tags in the Quality and Support Tool by sending an email to the Quality, Performance and Technical Support Team
• timely error feedback is discussed with the Service Officer as part of the coaching conversation to support any learning and development opportunities
• analysis of errors. That is, if errors occurred due to factors such as limited training, understanding the business rules, environmental or system based issues
• positive quality checking outcomes are acknowledged with Service Officers
• analysis of data to identify learning needs or process improvement opportunities

Quality Checkers are responsible for:

• carrying out quality checks as specified in the sampling plan
• updating and maintaining technical knowledge, procedures and policies
• maintaining a correctness standard for personal accuracy
• identifying root cause analysis and identifying systemic issues
• reporting and escalating trends or concerns to their Team Leader
• providing constructive and non-judgemental feedback including appropriate reference materials such as Operational Blueprint
• explaining the impact of errors and action to be taken to correct the error (where applicable) when providing feedback

Quality checkers must not check their own work. If their work is selected, it must be given to another staff member who has been trained to conduct quality checks.

Quality Team is responsible for:

• providing support for quality checking in the Quality and Support Tool (QST)
• providing relevant reports as required
• arranging QST training for quality checkers
• supporting the business with flexible and fit for purpose quality approaches

To attain accreditation, Quality Checkers must:

• have knowledge of relevant policies and procedures
• maintain a high correctness standard in the program they are checking
• understand the quality checking procedure
• meet accreditation standards

Pre-checks

Pre-checks apply:

• to new starters
• when new processes are introduced

New starters have 100% of their work reviewed and corrected until deemed proficient. Any errors made in pre-check must be recorded as errors.

Program/ Post-checks

Program/Post-checking randomly selects work completed the previous business day in the Processing and National Demand Allocation (PaNDA) WLM tool. The results are provided to management and external stakeholders as needed.

Targeted checks

These checks apply:

• in response to business triggers or when there is a consistent/long-term quality issue identified
• to Aim for Accuracy process (Check the Checker) completed every 12 months. This is to confirm the accuracy of quality checking results. The process involves rechecking a representative sample of previously checked work to determine if quality checking procedures have been followed correctly.

Pre-check

Pre-checks proficiency requirements for new starters will be advised in the scope of training details.

Program/ Post check

Three percent of the monthly total Provider Registration work types are randomly selected for quality checking.

Provider Registration processing has peak periods between December and April every year with the number of applications increasing significantly. During this time the amount of quality checking may be reviewed to help the prompt processing measures and workloads.

Targeted check

To arrange a targeted check(s), Team Leaders send an email request to Quality, Performance and Technical Support with the:

• percentage of work type to be checked. For example, 100%
• staff member's name and logon details
• quality checker's name and logon details
• the reason and length of time required for the targeted check
• details about how often a targeted check report is required. For example, weekly

Time frames

Quality checks are:

• undertaken daily on a random sample of work
• completed within 1-2 business days to ensure timely feedback

All quality checks for the month must be actioned within 3 calendar days of the following month. After this time, remaining work is abandoned.

Resources

Quality checkers must have access to the following to undertake quality checks:

• Program specific processing systems
• Processing and National Demand allocation (PaNDA)
• Quality and Support Tool
• Skill tags added on the Quality and Support Tool
• PRODA - Provider Digital Access through the Medical Portal/eBusiness system
• HPOS support through the Medicare Portal/eBusiness system

Provider registration source documentation

Provider registrations or amendments selected for quality checking can be actioned from several different types of sources. This includes but is not limited to:

• scanned application forms or letters for:
• provider number
• prescriber number
• 19AB exemption
• 3GA placements
• Recognition as General Practitioner (RACGP Fellow)
• capsule endoscopy applications and letters
• 19AB spreadsheet
• letters, emails or other correspondence received
• visas and passports/Australian Citizenship Certificate
• all registration/s and membership certificate/s

For quality checking, an error is information processed/keyed into the system which does not match the documentation submitted or the supporting documents uploaded to the systems.

Critical errors

An error is defined as critical when there is a potential risk to the:

• process affecting payments and/or information to Services Australia and its customers
• Services Australia's reputation

Non-critical errors

An error is defined as non-critical when there is no identifiable risk to the business process (payment and registration) and does not impact on Services Australia's reputation.

Non-critical errors are recorded as feedback and any action required is sent to the Service Officer for correction.

While non-critical errors are recorded as part of the quality checking process, they do not impact the quality result reported to stakeholders. Only critical errors are used to calculate the accuracy of processing results.

Each time a quality check is completed the Quality Checker records the outcome in the Quality and Support Tool (QST).

An email is sent in real time to the Service Officer and their Team Leader advising the quality check outcome.

Individual results are captured in QST.

Feedback is emailed to the Service Officer and their Team Leader. It gives details about the:

• check
• result (including any errors identified)
• quality checking dispute process

Managing and storing feedback

Feedback is recorded/stored in the Quality & Support Tool. Discussion notes about the feedback should be detailed in coaching sessions.

For critical and non-critical errors, Quality Checkers provide instruction in the feedback email.

Service Officers correct critical and non-critical errors. All corrections must be made as soon as possible once the Service Officer has been notified of the error.

Quality checking procedures are reviewed and updated by the business and program in consultation with Quality Operations & Technical Support. The review ensures error codes are current and approved policy changes are included.

Any changes that need immediate action will be advised and updated accordingly. Any changes not critical to quality will be incorporated in the review of the procedures.