Quality Management Application (QMA) quality checking in emergency claims 111-23103055

Work Items sampled for quality checking are automatically allocated via Workload Management (WLM) with a status of:

• QMA in Process Direct
• QMA on the Activity List (AL) screen in Customer First and Customer Record
• SUB on the Activity List (AL) screen in Process Direct
• SUB on the Event Summary (ES) screen in Customer First and Customer Record

To quality check a piece of work, QMOs must have the appropriate skills and access.

A work item may be allocated to a QMO who cannot complete it because they:

• do not have the appropriate skills or relevant skill tag at the correct level to check this work item
• receive their own QMA work item

If this happens, unassign the work item using Reason: Service Support Referral.

If the Process button is disabled, this may be because the QMO does not have :

• the Quality Management Officer skill tag, or
• the correct skill level applied to the skill tag (Experienced)

Check with QMO’s Team Leader/Manager about the skill tag or reallocation, if applicable.

Changing the QMA status - work item completed in Process Direct

When the QMA work item assessment is finalised in Process Direct, the system automatically updates the status from QMA to Completed.

Sometimes the work item status stays as QMA and it allocates again in WLM. If this happens:

• select the Question Mark icon to escalate the issue to ICT through Roxy
• if the Roxy function is unavailable:
• take note of the Customer’s Reference Number (CRN)
• go to the Customer Summary tile on the Process Direct landing page
• enter the CRN in the CRN field, select Go
• select the customer from the Search results
• the Circumstance Data screen will display in the customer's record
• select the Question Mark icon to escalate the issue to ICT via Roxy

ICT will manually change the status from QMA to Completed.

Procedure ends here.

Complete the relevant initial record checks. This can include, but is not limited to:

• principal place of residence (address at the time of impact) to determine if appropriate investigation has been conducted
• Marital Status (MS) screen to check correct information is recorded
• customer record links are correct, for example, partner/child
• residency requirements
• identity requirements
• scanned documents
• information on record relevant to the work item being checked, including Notes/DOCs

Select Process.

Go to the Entitlements (ELD) screen and any other required assessment screens:

• Check all rates and outcomes are correct
• This will also show any manual adjustments applied by the original staff member (where applicable)

Check the Notes for an explanation of any manual adjustments.

Go to the Errors (SWE) screen after completing the initial checks.

The Errors (SWE) screen will show:

• any warnings or errors in the Message Log for review
• the Task Selector:
• DRP_PS - Disaster Recovery
• QMA_SUM-QMA Summary
• Circumstances screens, when staff have completed updates

Select all tasks before selecting Next to start the quality check. Go to Step 2.

The system will cycle through all tasks that require quality checking. The Disaster Recovery Task can include the following:

• Residency Task Selector
• Customer Detail Task Selector
• Care Assessment (CAS)
• Payment Destination Details
• Other Government Payments (DRA only)
• DVA Payments (DRA only)
• Tax File Number Authorisation (DRA only)
• PITX – Tax Instructions (DRA only)
• Income and Assets Task Selector
• Disaster Recovery workflow

Each screen has No Error/Error buttons in the QMA Action column to record outcomes, except the Disaster Recovery workflow.

QMOs must:

• check all provisional data for correctness, and
• verify this against information in:
• the Claim Summary
• Notes/DOCs
• relevant source documents

If no error exists:

• select No error. The Q99999 error code will automatically apply
• QMA action options will update to Change and can be used to make updates if required
• select Next to check the next task

When all circumstance Tasks have been checked and no error outcomes were found, go to Step 4 to quality check the Disaster Recovery workflow.

If error/s have been identified, select Error, then go to Step 3.

Error configurations capture errors made in a work item.

Field error configurations

Each field updated by the staff member will display for quality checking.

Select the Error code icon to record the appropriate error code for each field:

• This must be done for all errors identified and only marked on the field where the error was found
• Do not add the same error/s to any other fields on the same screen

In the Comments box provide feedback:

• clearly stating what the error is
• referencing material that supports the coding, for example, Operational Blueprint

No error available for the field

If there is no error code available, apart from Q99999 no error, and an error needs to be recorded:

• send an email to the Service Delivery Quality - Tools team with a screenshot showing the field
• if feedback is required, use the Other errors identified field on the QMA Summary screen
• continue with the quality check

All errors have been marked

After all errors have been marked, select Set to autofill remaining fields with Q99999 no error. If:

• autofill needs to be undone, select Reset - this only removes all Q99999 no errors
• necessary, type over the Error Code field to change the Q99999 code

Select Submit

Select Next to check the next task. Continue through the circumstance tasks until all have been quality checked. Once all circumstance tasks have been checked, the Disaster Recovery question-based workflow will present for checking. Go to Step 4.

Note: for a list of error codes, see the Resources page.

The Disaster Recovery workflow will be the last task to check before completing the QMA check.

This is a question-based workflow and will display as Form in the Super Key field. The following are not available in the workflow:

• QMA Action column
• No-Error and Error buttons

When error/s are identified, record them on the QMA Summary in the Other errors identified field.

Review the details on the Disaster Recovery Payment Summary, then select Next to start the workflow.

The workflow presents as Read only when first reviewing the question-based workflow. QMOs cannot make any updates/corrections at this point. QMO’s must:

• Check all appropriate screens
• Take note of any errors

Once a review of the workflow is completed:

• Select Next to go to the QMA Summary to complete the QMA check

Go to Step 5.

The QMA Summary screen is the final screen presented in the quality check. The screen will show:

• screens updated by staff (except in the question-based workflow)
• any corrections made (except in the question-based workflow)
• QMO Feedback
• Other errors identified - this is a mandatory field, required for all quality checks

Use the Expand All button to ensure:

• all fields have a quality check outcome recorded, and
• feedback has been provided (where applicable)

After reviewing, go to Step 6.

This is a mandatory field that must be completed before finalising the quality check.

Select the Other errors identified field to record:

• errors that cannot be entered at the field level, including when Q99999 is the only option shown
• an error when a field was not updated, but should have been, and this impacts the customer’s outcome
• errors found in the Disaster Recovery workflow
• Q99999 - no error, where no other errors have been identified from the quality check either in or outside of the question-based workflow

Record the most appropriate error code and provide feedback where required. A QMA data validation error will display if an Error Code is not recorded in this mandatory field.

Note: when an error is already recorded on the circumstance screen:

• do not use the Other errors identified field to record the same error
• if there are multiple Other errors identified, select the Add button to insert a new line

Select Submit. Select Next to return to the SWE screen.

Were any errors identified in the Disaster Recovery workflow?

• Yes, go to step 7
• No, go to step 8

When errors are identified in the Disaster Recovery workflow, complete any corrections after finalising the QMA check, but before finalising the transaction.

The Disaster Recovery workflow will only be editable after the QMA Summary is completed.

Take corrective action if information was recorded incorrectly, and it:

• impacts the outcome of the claim (grant, reject or amount payable)
• does not impact the outcome of the claim, but results in incorrect notifications to the customer (rejections only)
• does not impact the outcome of the claim or send incorrect customer notifications

On the SWE screen:

• select DRP_PS - Disaster Recovery task. This will cycle through the Disaster Recovery workflow
• select Next

Complete the corrective action, if appropriate. When the workflow is complete, the system will go back to the SWE screen.

Can the transaction be completed now?

• Yes, select Assess to finalise the transaction. If an assessment error:
• presents on the SWE screen, go to Step 9
• does not present on the SWE screen, go to Step 11
• No, go to Step 8

In the following cases, the status of the transaction may need to be changed to In Process/In Progress/For Manual Action:

• claims cannot be rejected for the reason selected in the Disaster Recovery workflow. Place the claim on hold
• relationship details are incorrect, for example, incorrect date or partner or child
• it cannot be processed without regenerating the work item – this should be in limited cases and only if directed by an appropriate resource
• resetting the status of the work item is required
• a request for more information needs to be sent
• the current claim is not required, as the previous claim was rejected incorrectly and needs reassessing

Does the status on the transaction need to be changed for one of the above reasons?

• Yes, go to Step 10
• No, select Assess to finalise the transaction. If an assessment error:
• presents on the SWE screen, go to Step 9
• does not present on the SWE screen, go to Step 11

Use all available resources to resolve assessment errors. For help, see Using Digital Assistant Roxy in Process Direct.

If the error:

• is resolved, select Assess. Go to Step 11
• cannot be resolved and needs escalation to ICT or further action, go to Step 10

To remove the QMA status, go back to the QMA Summary to Reject the QMA check:

• Go to the QMA Summary screen
• In the Other errors identified field, code Q00024 error code. This is a non-proficiency (non-critical) affecting error
• Add an additional Other errors identified line to complete this action (if required):
• If no errors are found on the Other errors identified line, replace Q99999 code with Q00024
• If errors are found in the Other errors identified field, an extra line will be needed. Do not remove any existing error codes that were captured from the QMA quality check

Select Reject to complete the QMA check.

This changes the work item Status in Process Direct to In Process/In Progress/For Manual action.

• Complete all follow up action needed, including BAU processes. For example:
• request documents
• place on hold
• regenerate or escalate
• In Notes, record all actions taken because of the QMA check. This is because the work item will not be reselected for QMA checking. See Creating, reviewing and deleting documents (including Fast Notes and DOA DOCs)
• When the Reject button is selected, feedback will be available for the completed QMA check through the staff member's QMA Feedback tile
• The original outcome in the QMA Feedback tile:
• will be replaced with the new QMA outcome when changes are made to the original QMA check
• can only be changed before the transaction is finalised

If the transaction:

• is referred to ICT, procedure ends here
• needs another approved process to resolve the error, and the error is:
• resolved, select Assess to finalise the transaction. Go to Step 11
• not resolved, refer the work item to ICT using Been granted a bypass. Include the reference 111-23083013. Procedure ends here

Check the assessment outcome on the Entitlements (ELD) screen is correct.

If the ELD screen shows an incorrect assessment outcome:

• use the Super Key to go to the screen/workflow and update/correct/delete as applicable
• enter QMA in the Super Key field to go back to the QMA Summary screen
• record the error code:
• against the relevant field, or
• under the Other errors identified row
• provide feedback for any errors found
• select Submit to save the QMA outcome
• select Assess to continue to finalise the transaction

Are adjustments to the Period Rates Summary (RATS) / Rate Components (RAC) / One Of Payment (OOP) screen required?

• Yes, go to Step 12
• No, go to Step 13

If the staff member made an adjustment on the RATS, RAC or OOP screen, this must be re-coded. For example, to suppress arrears.

The staff member should have recorded Notes to explain any adjustments. Copy these Notes if they are correct.

Suppress letters

If any letters need to be suppressed:

• follow the relevant processes to supress any letters for the work item being checked
• ensure these letters remain suppressed

Once RATS/RAC/OOP adjustments are completed and/or letters are suppressed (where applicable), go to Step 13.

• Select Finish
• Add Notes for action taken
• Select Finalise
• Complete any BAU processes

Consider annotating or deleting the original staff member's Notes if they do not reflect the QMA outcome. See Creating, reviewing and deleting documents (including Fast Notes and DOA DOCs).

Procedure ends here.