Quality assurance and quality checking for external mail in Medicare 111-23101138

Correspondence incorporating free text must be checked by an appropriate quality checker/delegate:

• Service Centre Manager, or
• Team Leader (or a delegate by the Team Leader)

Each day a quality checker/delegate performs quality checking for all correspondence for that day based on business line requirements.

Note: quality checker/delegates must not perform quality checking on their own work. Another approved delegate must check the prepared the letter.

Quality check the following correspondence details:

• Date on the letter
• Recipient's name and address as per relevant database. For example, CDMS or Provider Directory System (PDS)
• Address letters in line with Australia Post standards
• Our Reference Letter templates for each program may be designed differently to cater for specific system requirements of each program. For example, (PaNDA work ID where work type is completed in PaNDA). For digital Medicare enrolments, use the Digital Medicare enrolments (DME) application ID. When no other reference details are available, staff’s Source Office Code may be used.
• Appropriate documents as required, that is, associated with claim or application. For example, make sure that another client’s documents have not been attached in error
• Signature of the staff member responsible for preparing the correspondence, only if required in line with business line processes
• No personal information unless it is relevant to the claim or application. For example, a date of birth should not be showing on an itemised claim statement sent to a customer
• Details on the envelope which match the details on the written correspondence
• For use of free text, make sure the content is accurate in following the business area’s policies and procedures. The content must also provide clear instructions for a customer to perform any required follow-up correspondence
• Services Australia logo in the letter must not be blurry

The Resources page has links to all the mandatory standards and the Writing Guide.

If errors are detected, provide feedback to the staff member for amendment and resubmission as required.

If no errors are detected, the checker/delegate must:

• check CDMS to make sure the letter has been sent to the correct customer appropriate for the work type
• make sure CDMS has been updated correctly with outgoing correspondence details as appropriate for the work type
• provide quality checking feedback as per business line procedure

Once the quality check is complete, and any errors corrected:

• place the letter in the outbound mail tray
• if viewing a digital copy of the letter, follow internal business line or team procedures in locating paperwork to make sure all documents are accessible as required (for example, in PaNDA, the letter is uploaded and relevant comments saved)
• if viewing a hard copy of the letter, go to Step 6

A copy of the letter that has been quality checked must be:

• signed and dated by the checker/delegate, and
• retained in the Service Officers daily batch

This is an additional copy of the letter that has been sent and is required for all written correspondence where work type is not completed in PaNDA.

For more about filing and batching archiving procedures, see Archiving and document retrieval for Medicare.

Correspondence must be checked by a delegate to make sure compliance with Services Australia guidelines.

• The delegate is a peer nominated by a Team Leader
• Each day the delegate must perform a quality check on correspondence for that day based on business line requirements
• Quality checking will make sure that the delegate confirms that the correspondence goes out to the intended and authorised customer as per business area procedures
• Correspondence with free text, must be quality checked by one of the following:
• Service Centre Manager, or
• Team Leader (or a delegate by the Team Leader)

Note: staff must not perform quality checks on their own work.

Quality check the following correspondence details:

• Date on the letter
• Recipient's name and address as per relevant database, For example, CDMS or PDS
• The letter must be addressed in line with Australia Post standards
• Our Reference (PaNDA work ID or Source Code and Logon ID where work type is not completed in PaNDA). For digital Medicare enrolments, use the Digital Medicare enrolments (DME) application ID
• No personal information unless it is relevant to the claim or application. For example, a date of birth should not be showing on an itemised claim statement sent to a customer
• Details on the envelope which match the details on the written correspondence
• For use of free text, make sure the content is accurate in following the business line's policies and procedures. The content must provide clear instructions for a customer to perform any required follow-up correspondence
• Appropriate documents, as required, that are associated with claim or application. For example, make sure that another customer's documents have not been attached in error
• Signature of the staff member responsible for preparing the correspondence may be required in line with business area processes
• Services Australia logo must not be blurry

The Resources page has links to all the mandatory standards and the writing Guide.

Has an error been detected?

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

• If errors are detected, provide verbal feedback to the staff member for amendment and resubmission as required
• Return documents to staff member

Note: incorrect letters must be placed in the secure documents bin.

If no errors are detected, the delegate must:

• take note of the WORK ID and add a PaNDA processing note to the file. For example, PCC (privacy check completed - P123456 or login details
• seal envelope and place in outbound mail tray
• provide feedback to the staff member who prepared the correspondence

Access the CDMS:

• Select Amend

Does the customer have a Medicare card number?

• Yes, go to Step 5
• No,
• If the correspondence relates to a claim, go to Step 3
• If the correspondence does not relate to a claim, CDMS does not need to be updated

The customer may be a claimant and entitled to receive Medicare benefits if they have incurred the cost of a service provided to an eligible Medicare patient.

Search CDMS to see if the claimant is already registered as a consumer. If a consumer ID is:

• Available, go to Step 5
• Not available, go to Step 4

Register the claimant as a new consumer on CDMS at Personal level only.

Note: never release a Consumer ID.

See also: Register a customer for Medicare in CDMS

• Key the customer Medicare number or Consumer ID and select Personal
• Select the Consumer ID option
• Select the Comments tab
• Key Letter sent and include a brief description of the reason for the letter
• Comments should have the channel of the claim, date of lodgement, required information to complete processing the claim and any contact attempts. For example:
• Letter sent - unable to process PaNDA patient claim, work ID XXXXXXXX (DOL 01/01/2018)
• Letter sent - documents left behind in SC, DOL DDMMYYYY
• Safety net Confirmation required. 2x contact attempts made; unable to reach customer

Note: do not enter an end date for the comment.

• Select Validate
• If the Indigenous status has not been entered, select Not stated
• Select Medicare (as the source)

A message will be returned to confirm if the details are acceptable:

• Select OK
• Select Validate
• Select Update

A comment has now been added to the recipient's record indicating a letter has been sent.

When customers call to request a Medicare form, Service Officers should tell them to go online and print one as this will be a quicker option for them.

If the customer is unable to print the form, advise them one will be sent by Australia Post. This may take a couple of weeks to arrive.

To send a form to a customer:

• Print out the form
• Place the form in an envelope
• There is no need to include a letter
• Clearly write the customer’s name and address on the envelope using the format:
• Mr John Smith
• 123 Elm Street
• Melbourne VIC 3000
• Team Leader to quality check (QC) the envelope
• Post the form

Staff to:

• create the relevant work item
• upload a new work item in PaNDA
• select from the drop down menu:
• Program: Miscellaneous'
• Worktype: Public QOL letters

See also: Create new work items - PaNDA Document Upload.

Staff must complete the following fields in PaNDA:

• key Medicare number in the Medicare Number field
• key Surname First Name in the Surname First Name field
• select Upload Document
• status as Open

Do not select the Assign to me on creation check box, unless uploading more than one document.

To upload additional documents:

• select the Assign to me on creation checkbox. Selecting the checkbox:
• assigns the work item to the user, and
• shows the work item in Worklist
• upload the additional document and add comments 'uploaded additional documents and item unassigned for checking'
• make sure the status of the work item is Open
• unassign the work item to return it back to the Public QOL letter pool for checking

See also: Processing and National Demand Allocation (PaNDA).

If the quality check outcome is error free:

• staff will not get an email from the quality checker
• the quality checker will print and post the letter to the customer

If the quality check outcome is error/s identified:

• the quality checker will correct the errors and the letter will be printed and posted to the customer
• the staff member's Team Leader will get feedback via the Staff Feedback Tool
• staff must review the feedback received and refer to the letter in the PaNDA folder (when required)

See also: Management of the Staff Feedback Tool.

Choose the relevant option:

Statement Of Benefit letters + Read more ...

Debt letter- Overpayment over $100 + Read more ...

If the quality check outcome is:

Error free + Read more ...

Error/s identified + Read more ...

The quality checker must:

• select Ready at bottom right of the Worklist screen to get a new work item in Work Optimiser
• quality check the relevant work item

See Managing work using the Worklist.

Note: the quality checker must refer to the relevant Program/Policy escalation process in Operational Blueprint if they need technical help.

If the quality check outcome is:

Error free + Read more ...

Error/s identified + Read more ...