Technical Support and Escalations - Medicare Compensation Recovery 011-15040000

Research the enquiry thoroughly using all available resources for example:

• when talking with the customer, actively listen to their request, asking questions to gain a clear understanding of the enquiry
• use online tools and reference material to fully research the enquiry, including:
• Operational Blueprint
• Medicare Compensation Recovery SharePoint
• Network News Update (NNU)
• mySupport

Service Officers can make evidence-based decisions within their delegation using the REFLECT model, see Document Assessment - Medicare Compensation Recovery

Was the enquiry resolved?

• Yes, procedure ends here
• No, go to Step 2

Service Officers should ask their peer support network for help before lodging a Tier 1 support request.

When using the peer support network:

• check that the service officer is not assisting a customer and has time to help
• keep the question simple and easy to confirm or clarify
• any resources used in the research must be shared with the Service Officer
• if the assisting service officer has accessed the file or case, they must be included in the case note review

The role of the peer support network is to provide assistance only. It is the responsibility of the Service Officer to make a decision and assess the case or claim using evidence-based details that align with policy and procedure. If they are not confident in the advice, they should access Tier 1 support.

Does the Service Officer need further technical support?

• Yes, see Table 2
• No, procedure ends here

Request Tier 1 technical support using the Tier 1 Support tool.

Provide all details, including:

• the question or enquiry to resolve
• the recommended outcome
• all resources used to research the enquiry before asking for Tier 1 support
• all relevant Case IDs
• Work Identification Number (WIN), if applicable
• background of claim, including:
• timeline of key events,
• actions already taken
• previous advice/decisions or documents received

Do not include sensitive customer information such as:

• customer names
• dates of birth or
• Medicare card numbers

Tier 1 Support cannot submit a support request on behalf of another staff.

Requests can be marked as Urgent.

All requests must be marked as:

• On Phone, or
• Processing

Is support required during an ongoing phone call?

• Yes, customer is currently on the phone:
• Submit the support request as On Phone
• Go to Step 2
• No, customer is not on the phone (Service Officer is on processing duties or request is submitted after call has ended):
• Submit the support request as Processing
• Add a case note to show Tier 1 Support request lodged and the reason for the request
• Hold to User any related work-items
• Complete other work while waiting for a response
• Go to Step 8

Tell the customer that you are placing them on hold to seek technical advice and there may be an extended wait.

Is the customer willing to wait on hold?

• Yes, go to Step 3
• No:
• Tell them the agency will attempt to contact them with the outcome and that the call will come from a private number
• Confirm and record the customer’s best contact number
• End the call
• Add a case note showing the reason for the Tier 1 Support request
• Action other work while waiting for a response
• The Tier 1 support request must be changed to Processing. Go to Step 4

The Tier 1 Support phone line is available during business hours except for scheduled meetings.

Call the Tier 1 support line for assistance while the customer is on the line using Services Australia Workspace (iWS):

• Start a consultation
• Select Medicare Compensation Recovery PSO from the Softphone favourites menu. The system automatically places the customer on hold
• Do not select 'Instant Call Conference' or 'Instant Call Transfer' unless directed as this will connect the customer directly (cold transfer)

The Resources page contains a link to Services Australia Workspace (iWS) task cards

The Tier 1 Support officer will:

• review the support request in the online tool
• review the claim
• discuss the enquiry with the Service Officer, including details of any actions to take

To share the screen at the request of The Tier 1 Support Officer, using Microsoft Teams:

• Key the Tier 1 Support Officer’s name into the search bar of Microsoft Teams
• When correct page populates:
• Select the ellipsis (...) from the tool bar
• Select Screen Sharing
• Do not start an audio or video call as this will duplicate with the consultation call

For calls where the:

• customer declined to wait, go to Step 4
• Tier 1 support phone line is not available, or there is no answer after five minutes, go to Step 4
• Tier 1 support officer will take over the call, go to Step 5
• issue was resolved and the call is:
• ended by Tier 1 Support, go to Step 6
• returning to the Service Officer, end the consultation call to return to the customer. Go to Step 6

When the customer has declined to wait, the phone line is not available, or there is no answer received after five minutes:

• Do not wait for a Tier 1 staff member to become available. Return to customer call
• Confirm and record the customer’s best contact number
• Tell the customer the agency will attempt to contact them with the outcome and that the call will come from a private number
• End the call
• Add a case note showing the reason for the Tier 1 Support request
• When Tier 1 Support is still needed:
• select Edit icon in the first column of the request form
• change the Status of the request to Processing
• If Tier 1 Support is no longer needed, select Withdraw. Withdrawing a request does not delete the data from reports and this action cannot be undone
• Action other work while waiting for a response

When the Tier 1 Support Officer agrees to take over the call, in Services Australia Workspace (iWS):

• Select Instant Call Conference to warm transfer the call
• Introduce the Tier 1 Support Officer to the customer
• Remain in the call with microphone muted (unless otherwise advised)

If the Tier 1 Support Officer:

• needs to escalate the call, go to Step 6
• resolves the customer's enquiry and the customer disconnects:
• remain on the call with the Tier 1 Support Officer
• discuss the outcome of the call and further actions needed including any learning opportunities for future challenging situations
• add a case note detailing the outcome of the call and any further actions needed
• resolves the customer enquiry and returns the call to the Service Officer:
• complete the customer enquiry using the details given by Tier 1 Support
• add a case note detailing the outcome of the call and any further actions needed
• finalise the customers enquiry and tell them about any expected letters or payments

When Tier 1 Support cannot complete the customer enquiry and the case needs escalating:

• Tell the customer the agency will attempt to contact them with the outcome and that the call will come from a private number
• Add a case note detailing the reason for escalation, where the case was escalated to and any outstanding items still needed
• Confirm and record the customer’s best contact number

After completing the request:

• Tier 1 Support will record the outcome of the contact in the Tier 1 Support tool
• an email with the details of the contact and resolution is automatically sent to the Service Officer

The Service Officer must:

• action the feedback and complete processing of the work item in their next scheduled processing time, before opening any new work items
• review all resources provided
• add case notes on the appropriate system

If the feedback:

• shows escalation to Tier 2 (SSO5) and Tier 3 (PM) is needed, see Table 5
• is not clear or further explanation is needed, lodge a new Tier 1 Support request

When scheduled for Tier 1 support accredited staff must:

• continuously monitor the requests that come through the Tier 1 Support tool in Admin access
• respond to consultation calls from Service Delivery on the Tier 1 Support phone line

For technical support contact requests that are received by:

• phone - go to Step 2
• online form - go to Step 5
• Microsoft Teams direct message, email, in-person or other methods:
• tell the Service Officer to submit a request using the Tier 1 Support tool
• Notify Team Leader of contact through inappropriate channels. Procedure ends here

Tier 1 Support staff must not submit requests on behalf of other staff.

For Tier 1 Support requests where the customer is:

• on the phone and the request was submitted using the Tier 1 Support tool, go to Step 5
• not on the phone or the request was not submitted using the Tier 1 Support tool, where the Service Officer is:
• from Medicare Compensation Recovery, go to Step 3
• not from Medicare Compensation Recovery, go to Step 4

A Tier 1 support request must be submitted for every contact.

For a Tier 1 Support request where the customer is:

• on the phone and the Service Officer needs help during the on-going call:
• make sure the Service Officer has submitted an On Phone request
• once the Tier 1 Support request is submitted, go to Step 5
• not on the phone:
• tell the Service Officer to submit a Processing request. Tier 1 support will action the request within the appropriate priority order.
• end the call with the Service Officer
• procedure ends here

Service Officers not trained in Medicare Compensation Recovery do not have access to the Tier 1 Support referral form.

Ask for the Service Officer‘s logon.

When the Service Officer is:

• from Medicare and has a COMP TAC enquiry tell them to call the Medicare Compensation Recovery general line
• requesting to warm transfer a customer, where the call is:
• sensitive, urgent and/or about a complex claim - accept the call
• not sensitive, urgent and/or about a complex claim - tell them to cold transfer the call to the Medicare Compensation Recovery general line
• requesting customer or claim details, all these requests must be actioned by Program Management (PM). PM will confirm the business need for the details and where appropriate, authorise the request. See Table 5
• contacted in error or the call is about general information, tell them to contact the Medicare Compensation Recovery general line

In all cases, general assistance can be given for enquiries:

• about Medicare Compensation Recovery or
• without disclosing any customer or claim details

If the customer file or claim are accessed, the Service Officer must enter a case note including:

• Service Officer logon
• details about the access

Open the Admin access level in Tier 1 Support tool.

Excluding a current consultation call, or Team Leader priority request, items in the Tier 1 support tool are actioned in the following order:

• Urgent - On Phone
• Urgent - Processing
• Processing

Using the appropriate priority, requests are then actioned in order starting with the oldest request.

When actioning a request:

• Select the oldest request using the Edit icon in the first column
• Do not select requests with a status of Under Review
• Hold the item, select:
• the request and change the status to Under Review
• Update and Close
• Re-select Edit from the list to open the request for action. This will stop other staff from working on the same item

The Tier 1 support officer must complete a full assessment of the claim before responding to the support request.

Complete mandatory checks and use all available resources including:

• Operational Blueprint
• Medicare Compensation Recovery SharePoint
• Legislation
• MCRS:
• claim history
• case history
• case notes, documents
• related claims
• RCA search
• SAP GUI
• CDMS
• Relevant Medicare Mainframe screens, for example NCRI and NHSI
• Email inboxes for:
• Compensation Recovery
• Operational Support
• Leadership. For example, archived remittance advices, or to view, search and resend original emails from the Compensation Recovery inbox

In some circumstances the Tier 1 Support officer may not be able to action the request. For example:

• scheduling availability
• inadvertent access

In these cases:

• select Return to Pool
• change the Status to New. The request is now available to other Tier 1 Support staff

For requests that show the Service Officer channel as On Phone, go to Step 11

For all other requests, go to Step 8

While there is no requirement for a Tier 1 Support Officer to contact the Service Officer when actioning a Processing request, contact may be appropriate to:

• explain:
• complex and/or time-sensitive advice, processes and decisions
• the process in detail if a second or subsequent support request is received for the same issue
• clarify the Service Officer’s request
• provide details using available resources including screen sharing
• obtain sensitive information that is not included in the request

If the request includes inappropriate comments or sensitive customer details the Tier 1 Support Officer must contact the Service Officer to have the comments or details removed.

Will Tier 1 Support contact the Service Officer?

• Yes, go to Step 9
• No, go to Step 14

Use Microsoft Teams direct message to check if the Service Officer is free to discuss their Tier 1 support request.

Include the case ID and Work Identification Number (WIN), if available, to help the Service Officer locate the claim.

When the Service Officer is ready, contact using one of the following secure channels:

• Microsoft Teams using direct message or audio/video call
• Softphone
• Email, if no other options are available

For requests that need updating due to inappropriate comments or sensitive customer details:

• the Service Officer must change the details. Tell them to:
• select Edit icon on the request
• make the appropriate changes
• Save and close
• explain the reason the content is inappropriate
• exit then reopen the request to see the changes

If the Service Officer was:

• contacted, go to Step 14
• not contacted, go to Step 10

For a request that can be finalised:

• using the available details, include details of resources for the Service Officer to review in the feedback
• as the Service Officer needs to provide more details before the request can be completed. The request is closed and the Tier 1 feedback must include:
• an explanation for the closure of the request
• an outline of the outstanding details (if appropriate) and
• a direction to submit a new request if assistance is still needed
• Go to Step 16

If Tier 1 Support must contact the Service Officer:

• Leave the item Under Review
• Select Update and close to return to the list of support requests
• Select a new support request and continue with Tier 1 Support
• Return to the Under Review request periodically as appropriate until Service Officer contact is made

If the issue is not resolved within 2 working days, discuss next steps with a Team Leader. For example, they may transfer the work item to another Service Officer

For Tier 1 Support where the customer is on the phone ask the Service Officer to outline the details of the customer's enquiry.

If the customer enquiry is:

• general or easy to resolve assist the Service Officer during the call. Go to Step 14
• about a customer service issue, for example, inappropriate staff behaviour or time frames:
• tell the Service Officer to escalate the call to a Team Leader
• go to Step 13
• for a technical or complex issue that the Service Officer is unable to resolve, the Tier 1 Support Officer can take over the call. Go to Step 12

When a Tier 1 Support Officer agrees to accept a call transfer, the Service Officer must:

• return to the customer and tell them they are being transferred to a technical advisor
• warm transfer the customer to the Tier 1 Support officer using the following transfer options in Services Australia Workspace (iWS):
• Instant Call Conference from an existing call consultation. Where appropriate, the Service Officer must mute their microphone and listen to the call. This helps to improve their capabilities and build confidence and understanding
• Instant Call Transfer. Only if instructed to by the Tier 1 Support Officer. This option is used when a Tier 1 Support Officer needs to speak with the customer and does not need further involvement with the Service Officer that referred the call

The Tier 1 Support Officer will support the customer with their enquiry and give them details about:

• the reason for a decision or action
• any further actions the customer needs to take
• what to expect moving forward
• the customer's options if they disagree with a decision
• any relevant legislative timeframes or reasons for processes

When the customer:

• is aggressive or abusive:
• see Telephone Standards
• see Enquiries and authenticating a customer for relevant Medicare Compensation Recovery processes
• ask Team Leader for help with de-escalating the aggressive behaviour. Go to Step 13
• wants to make a complaint:
• refer them to the Website to submit a complaint online
• offer to transfer them to the Complaints line. Service Officers must warm transfer the call and explain the details to the complaints officer before transferring the customer
• wants to talk about a customer service issue, go to Step 13

Once the customer disconnects, before ending the consultation with the Service Officer, the Tier 1 Support Officer will go through the following:

• confirm the Service Officer’s understanding of any further actions needed
• suggest learning opportunities and resources to help educate and support the Service Officer in future challenging circumstances. (This must not be done while the customer is still on the line)

Go to Step 14

To escalate a customer call where the Team Leader is:

• available:
• tell the customer you will transfer them to a Team Leader
• warm transfer the customer. See, Table 6 in Enquiries and authenticating a customer
• not available:
• tell the customer a Team Leader will call them back from a private number, within 2 working days
• confirm and record the customer’s best contact number
• address any other concerns and end the call
• leave a case note including details of all actions taken and that the call was escalated to a Team Leader
• email Compensation Operational Support (Service Support Officer (SSO5)) to request a call back. Include the Work Identification Number (WIN), customer’s phone number and a summary of the reason for escalation

To finalise the support request, go to Step 16

Was the Tier 1 Support Officer able to resolve and complete the request?

• Yes, go to Step 16
• No, needs further action:
• confirm and record the customer’s best contact number
• tell the customer they will be notified of the outcome within 2 business days
• follow up as needed
• No, needs escalation to Tier 2 or higher, go to Step 15

Tier 1 Support requests that are not resolved can be escalated to:

• Tier 2 support - Service Support Officers (SSO5)
• Tier 3 support - Program Management (PM)

The Tier 1 Support Officer can:

• tell the Service Officer to escalate the enquiry
• self-escalate the request

See Table 5 for more details on escalating the request.

Record a case note in MCRS including:

• Service Officer logon
• Request received
• Tier 1 assessment and advice, for example,
• actions needed by the Service Officer and any other staff
• actions taken by Tier 1
• escalation details (if appropriate)
• resources used in decision making

Open the Admin access level in Tier 1 Support tool:

• Record the above details
• Confirm Primary and Secondary Enquiry details. The autofill can be used where Service Officer has selected correct details
• Select appropriate Resolution from the dropdown box
• Select appropriate option from Service Officer Checked dropdown box
• Include Tier 1 support provided resources for the Service Officer to review
• MCR Communications
• Operational Blueprints
• Technical sessions
• Training resources
• Select checkbox if needed for:
• OB feedback required
• Learning need identified
• Incorrect Resources used
• Include a response to Service Officer in Tier 1 Support comments
• Select Finalised to complete the support request. An email to for the Service Officer to action is automatically generated in SharePoint as a response to the request

Send feedback to Operational Blueprint when, the Operational Blueprint:

• is incorrect or could be improved
• is not clear
• has old or missing information
• did not show in search results as expected

Notify your Team Leader of any emerging concerns, including:

• multiple similar enquiries from same Service Officer
• recurring or emerging trends

If requested, make sure an email is sent to formally document the issue. This creates a clear audit trail to support the resolution and follow up of the request.

Escalate any unreported system related issues to Tier 2 and PSM via the MCRS Issue Escalation form. This form is for use by Tier 1 support only.

The Resources page contains a link to the SharePoint and MCRS Issue Escalation form.

Level 1 Support Officers must action complaints that are issued as a work item in in Work Optimiser - Health (WO).

The Service Officer will take ownership of the complaint work item and attempt to resolve the issue for the customer.

To receive a work item:

• Open Work Optimiser - Health
• Select Worklist
• Select Ready. The new work item will show on the Summary screen with Work Type Level 1 Feedback- Medicare Compensation Recovery (ZFSR_FBK_MCR)
• Copy the Feedback ID (10 digit Work Item ID, for example, 8000xxxxxx)

Before making any updates and taking ownership of the complaint, the Level 1 Support Officer must confirm the complaint work item is for Medicare Compensation Recovery.

Complete a full check of the complaint in Customer First and MCRS (if applicable) to identify any:

• administration errors
• delays to processing

View and action all complaints in Customer First.

To access the complaint:

• Open Front of House Application
• Select Medicare Customer First tile
• Select business role ZCFS_ICF_MGR-Integrated Customer Feedback
• Select Agent Inbox from the menu on the left
• Select Clear
• Key Feedback ID into the Feedback ID field
• Select Search
• Select the Customer Feedback ID

When accessing Customer First for the first time, the Service Officer can change the order of the Customer First tabs to show the most common tabs first. Highlight the line and drag to the most suitable position in the list.

The most commonly accessed tabs for compensation complaints are:

• Details - shows the receipt date and gives general information about the complaint, including:
• Feedback Status - must be updated as the complaint assessment progresses
• Acknowledgement Date -the date the complaint was acknowledged
• On Hold Expiry Date - must be updates as appropriate to prevent the item being reassigned in WO
• Unsuccessful Call Attempts - must be updated for each unsuccessful attempt
• Notes - select the edit icon to record details of the assessment
• Notes History - contains the contents of the complaint and a note history
• Remedy Details - use when finalising the complaint
• Reason for Escalation - only used when a complaint is escalated to level 2
• Parties Involved - for picking up and assigning the complaint

Is the work item a complaint for Medicare Compensation Recovery?

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

If the complaint is for Medicare Compensation Recovery, assign the complaint work item.

• Key Feedback ID into the Feedback ID field
• Select Search
• Select the Customer Feedback ID
• Select Parties involved
• Select open Input Help icon on the empty field and search name/logon
• Select name
• Select Employee Responsible from the dropdown box

To action the complaint, see:

• Level 1 - Online feedback, to action and manage online complaints, suggestions and compliments.
• Level 1 - Manage complaints and feedback, to action and manage all Level 1 customer complaints and feedback types.

Once all relevant actions are complete, call the customer to tell them the outcome of the investigation.

If the customer contact number is not provided or reasonable attempts to contact the customer are unsuccessful:

• issue the relevant system correspondence to the customer telling them the of outcome of the complaint
• leave a case note on the claim in MCRS that includes all actions taken

Entries in the Customer Feedback Tool (CFT) can be accessed by staff outside of the Compensation area.

For effective complaint handling and cross-team collaboration all case notes must be clear, consistent and written to support transparency, professionalism, and accessibility.

See Recording complaints and feedback in the Customer Feedback Tool.

Procedure ends here.

After the check is complete, any complaint that is not related to MCR must be escalated to a Team Leader.

The Team Leader will contact the Operations Management Division to have the enquiry redirected.

The Work Item will display on your worklist until the Operations Management Division are able to transfer it to the correct department.

Procedure ends here

Is the work item at the Evaluate screen?

• Yes:
• Leave a clear case note detailing the reason for escalation. See Table 6 in Claim management - Medicare Compensation Recovery
• Select Escalate to SO5, or Escalate to PM. A pop-up message shows: ‘Have you provided an appropriate case note and now want to escalate the task to…’
• Select Yes
• Procedure ends here
• No, the work item has progressed past the evaluate screen:
• Leave a clear case note detailing the reason for escalation. See Table 6 in Claim Management - Medicare Compensation Recovery
• Select Save
• Select X to exit work item
• Go to step 2

The work item must be unassigned in Work Optimiser - Health.

On the My Work page:

• select the Work Item ID (tick the box)
• select Actions from the bottom right of the screen
• select Unassign

To re-categorise the work item for escalation:

• select Reason: Re-categorised
• select Work Type escalation options:
• MCRS_PRIORITY_SO4 for priority processing
• MCRS_REVIEW_EXT for review of extension decision by an APS4
• MCRS_REVIEW_REFUSAL for review of a refusal decision by an APS5
• MCRS_PM_ESC to escalate the work item to PM where the button does not show in MCRS
• MCRS_SSO5_ESC to escalate the work item to an APS5 where the button does not show in MCRS
• select Submit

Do not re-categorise a work item to SO4 priority unless exceptional circumstances exist.

If a Service Officer receives a work item that they are not trained in, escalate to relevant work type through Workload Manager see Table 6

When a claim is escalated to PM for advice, the Program Officer must:

• evaluate the claim based on documents and case notes provided
• assess the escalation based on the request for advice from Service Delivery
• include a clear case note. See Table 6 in Claim Management - Medicare compensation recovery. The case note must include:
• a detailed response
• any decisions made
• clear instructions for Service Delivery to action
• save the enquiry

To send the work item back for completion by a Service Officer:

• select X to exit the work item
• open Work Optimiser
• select Unassign
• select Re-categorised from the Reason dropdown box
• select MCRS_SD_Action from the Work Type dropdown box
• select Submit

When a Service Officer does not have the skills or training to action a work item, they can reallocate the work item to a suitably skilled Service Officer using the Proficiency Raise function.

Is the work item an unclassified document?

• Yes, see Table 6 in Mail process and Work Optimiser - Medicare Compensation Recovery
• No, go to Step 2

The Service Officer must leave a clear case note on the work item detailing the reason for proficiency raising the work item, then:

• Select Save
• Select X to exit the work item

Open Work Optimiser - Medicare, My Work page:

• Select the Work Item ID (tick the box)
• Select Actions from the bottom right of the screen
• Select Unassign
• Select Proficiency Raise