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Technical Support and Escalations - Medicare Compensation Recovery 011-15040000

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Contact details

Medicare Compensation Recovery includes Tier 1 Support, Tier 2 Support (SSO5) and Tier 3 Support (Program Management) contact details

Complaints

Escalation reasons

Table 1: contains a list of possible reasons for escalating an issue and whether the issue should be escalated to a Tier 2 (SSO5) or Tier 3 (Program Management). Before escalating any issue Service Officers must contact Tier 1 Support for assistance unless directed by Operational Blueprint to escalate directly.

Reason for escalation

Delegation level

Service Officer unsure if claim is notifiable see Notifiable and not notifiable claims - Medicare Compensation Recovery

SSO5

Service Office is unsure if there is sufficient evidence supplied for an Amendment of a valid Notice of past benefits (NOPB) prior to settlement. (only after Tier 1 support contact). See, Extensions, decisions and reviews - Medicare Compensation Recovery

SSO5

Incorrect refund recipient

SSO5

Care costs checks (automatically escalated by MCRS). See the Table 1

in Statement by claimant (SBC) - Medicare Compensation Recovery

SSO5

Care cost amount breakdown

SSO5

Amendment of previously verified Notice of charge (NOC) after settlement.

Before escalation, see Resources page in Extensions, decisions and reviews - Medicare Compensation Recovery

.

SSO5

Bulk Payment Agreement (BPA) claims

Program Management

Complex processing - Service Delivery processing options exhausted

Program Management

APS5 tells the Service Officer to escalate to Program Management

Program Management

Out of scope for Service Delivery, for example:
  • Program Management need to send email or letters that are not available to Service Delivery
  • Advice on complex situations
  • Actions required on claim for incarcerated customer of deceased estates (for example, refunds with no ATP, no MO024)

Program Management

Specific legal advice within scope of the Health and Other Services (Compensation) Act 1995

Program Management

Approval for payments to third party

Program Management

Approval of declarations made on Commonwealth of Australia statutory declarations

Examples:

  • Statutory declaration completed by parent of a minor stating the minor is incapable of handling their own affairs
  • Injured person dies intestate, and a Service Officer needs advice on the next course of action

Program Management

Internal MCR staff compensation claim - for processing

Program Management

Any claim where payment was made under DIV. 3A (i), (ii), (iii) of the Accident Compensation Act 1985 (Vic). See Notifiable and not notifiable claims - Medicare Compensation Recovery

Program Management


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