Contact details
Medicare Compensation Recovery, use for:
- Tier 1, 2 and 3 support, and
- Medicare Compensation Recovery Team Leaders
Scenarios for accepting subsequent partially returned SBC’s
Table 1: outlines whether to accept a subsequent partial SBC in various scenarios. This is not an exhaustive list, if Service Officers are unsure contact Tier 1 support for assistance.
Scenario – initial SBC received | Actions by IP/Claimant in response to Z2805 | Service Delivery Action |
SBC returned - incomplete services statement due to missing pages, complete and valid care services statement, and complete and valid declaration page. Or SBC returned - incomplete services statement with all pages included however errors or unclear ticks making it invalid, complete and valid care services statement, and complete and valid declaration page. | In response to the Z2805, only the missing pages are returned. In response to the Z2805, only the re-completed pages are returned. | Accept return of missing pages – previously returned pages do not need to be resent in this instance. Accept return of completed services statement pages – previously returned care services statement and declaration page do not need to be resent in this instance. |
SBC returned - complete and valid services statement with all pages included, complete and valid care services statement and incomplete or invalid declaration page. | In response to the Z2805, only the complete and valid declaration page is returned. | Accept return of completed declaration only – services statement pages and care services statement do not have to be returned in this instance. |
SBC returned - complete and valid services statement with all pages included, incomplete and invalid care services statement, and complete and valid declaration page. | In response to the Z2805, only the complete and valid care services statement is returned. | Accept return of completed care services statement only - services statement pages and declaration do not have to be returned in this instance. |
SBC returned - incomplete services statement due to missing pages, complete and valid care services statement, and complete and valid declaration page. | In response to the Z2805, the full SBC is returned with different services indicated on the services statement, complete and valid care services statement, and complete and valid declaration | Accept the most recent SBC as valid and complete for processing purposes. |
Table 2: amendment request to Notice of past benefits (NOPB) Pre-settlement or Notice of past benefits - advance payment (NOPB-AP)/ Notice of charge (NOC) - Post settlement
Category | Actions |
Amendment request to NOPB - Pre-settlement | The entire re-completed SBC must be returned. The SBC must be the most current Notice to claimant (NTC) issued. SBC includes: - All pages of the services statement, and
- Care services statement, and
- Declaration that was issued as part of the NTC.
Refer to Incomplete or amended SBC for further information regarding amendments pre-settlement. If the initial submission of the SBC for amendment is invalid, the entire valid SBC must be returned again before the amendment can proceed. |
Amendment request to NOPB-AP or NOC - Post settlement | The entire re-completed SBC must be returned accompanied by medical evidence (for example, a letter from a treating medical practitioner) or a completed statutory declaration. The SBC must be the most current NTC issued. SBC includes: - All pages of the services statement and
- Care services statement and
- Declaration that was issued as part of the NTC.
See Extensions, decisions and reviews - Medicare Compensation Recovery for more comprehensive information regarding amendments post-settlement. If the initial submission of the SBC for amendment is invalid, the entire valid SBC and supporting evidence must be returned again before the amendment can proceed. |
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