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Escalations - Medicare Compensation Recovery 011-15040000

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Contact details

Medicare Compensation Recovery for Program Support Officer (PSO) hotline and email

Medicare Consumers Program Support - Medicare Consumers Section - Medicare Branch

Escalation scenarios

This table is a list of possible escalation scenarios and lists whether to escalate to an APS5 or Program Management for advice or action. This is not an exhaustive list, if Service Officers are not sure, contact a Program Support Officer (PSO) for assistance.

Scenario

APS5 or Program Management

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

APS5

Amendment of Notice of past benefits (NOPB) prior to settlement if the Service Officer is unsure if sufficient evidence provided (only after contacting PSO for support)

APS5

Incorrect refund recipient

APS5

Care costs checks (automatically escalated by MCRS). See the Table 1 in the Statement by claimant (SBC) and care costs - Medicare Compensation Recovery

APS5

If claim meets the criteria for subsequent extension, notice of refusal or amendment, see the Resources page of Extensions, decisions and reviews - Medicare Compensation Recovery

APS5

Bulk Payment Agreement (BPA) claims

Program Management

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

First refer to the Resources tab of Extensions, decisions and reviews - Medicare Compensation Recovery for further information

Program Management

Complex processing - Service Delivery processing options exhausted

Program Management

Service Officer advised by an APS5 to escalate to Program Management

Program Management

Out of scope for Service Delivery, for example:

  • Requirement for Program Management to send email or letters that are not available to Service Delivery
  • Advice on situations
  • Actions required on claim for incarcerated IP (e.g. 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

Second extension requests

Program Management

Approval of declarations made on Commonwealth of Australia 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 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 Transport Accident Commission on Background page in Notifiable and not notifiable claims - Medicare Compensation Recovery

Program Management

Privacy and Secrecy