Close, terminate or reopen a claim - Medicare Compensation Recovery 011-15040040

• A 'closed claim' is different from a 'terminated claim'
• Closed claims can be reopened, whereas terminated claims cannot
• MCRS automatically closes a claim after a Notice of charge (NOC) or Notice of past benefits - advance payment (NOPB-AP) has been issued
• Service Officers can manually close a claim under specific scenarios
• Terminated claims are terminated by a Service Officer, with no notice issued

Reopening a claim

Closed claims can be reopened to allow for further actions to be taken, as necessary. Scenarios for reopening a claim may include the requirement to:

• make changes to the Notice of judgement or settlement (NOJS) details, or
• amend a Notice of charge (NOC) / Notice of past benefits - advance payment (NOPB-AP)

An amendment to a final NOC / NOPB-AP may occur if an:

• injured person/claimant/authorised third party submits a completed Statement by claimant (SBC) after a claim is closed on an all services included NOC / NOPB - AP
• injured person/claimant/authorised third party submits a revised SBC as part of the evidence to request an amendment to a NOC / NOPB - AP
• error in processing is identified

If a legacy claim is reopened, or if the Is an update to existing details required? Button is selected when reopening a claim. MCRS automatically navigates to the Update screen. The Service Officer must make sure the claim details and information are current.

In all other instances, MCRS will present the Capture NOJS details screen or Capture NORA details screen where either of these document types are selected to reopen the claim. Mandatory checks must still be done.

See Document Assessment - Medicare Compensation Recovery

The Process page contains information about how to reopen a claim.

The Resources page has a list of actions available on a closed claim versus a terminated claim.

Actions on a closed claim without reopening

Action can be taken on a closed claim without reopening.

Scenarios appropriate for not reopening may include:

• issuing a refusal letter
• attaching a document which requires no action, for example, duplicate or incomplete documents, and updating customer details

The following actions can be completed on a closed claim using Restricted Claim Access:

• Record a case note
• Resend correspondence (only correspondence generated in MCRS can be resent using this option)
• Unlink documents
• Send stale cheque correspondence
• Rename documents
• Set sensitivity category, See Claim Management - Medicare Compensation Recovery

Close claim function in Actions menu

A claim can also be closed using the Close claim option in the Actions menu. This option should be taken if a claim is:

• re-opened in error, or
• re-opened to escalate an amendment request to APS5 or Program Management that is subsequently not granted

Before using the Close claim option, all enquiries must be finalised. Any updates or changes made on cases which are not finalised will not be saved when the claim is closed in this way. This function is available to Service Officers at any step in a case lifecycle, except during Update claim details. If the Update claim details button is selected at the Evaluate step the Close claim option will not be available.

See:

• the Process page for a refusal letter, how to attach a document and update details
• Claim Management - Medicare Compensation Recovery for case notes
• Medicare Compensation Recovery for resend correspondence
• Process Correspondence - Medicare Compensation Recovery for unlinking documents
• Notice of reimbursement arrangement (NORA) - Medicare Compensation Recovery or Notice of judgment or settlement (NOJS) - Medicare Compensation Recovery for how to close a claim

Service Officers must terminate a claim in MCRS if:

• an incorrect person was selected. To assess if a privacy incident has occurred, see Privacy incidents
• the claim:
• settled in favour of the notifiable person (defendant)
• settled on an amount less than $5,000
• was never lodged with the notifiable person
• was withdrawn (discontinued) by the injured person
• was dismissed by a court
• was part of another claim which settled
• is not notifiable
• is inactive (this is a Program Management decision)
• has been registered twice in error (duplicate registration)
• a reimbursement arrangement was made less than 6 months after the claim was made
• advised by Program Service Manager (PSM) as no further processing can occur in MCRS

Note: denial of liability by the notifiable person is not a reason to terminate the claim.

Multiple claims against the same notifiable person for the same injury/illness and for the same compensation type are treated as a combined claim and closed under a single work item number (WIN). The oldest WIN will be amended to reflect any changes to Date of injury/illness (DOI) or the injury description, and subsequent WINs must be terminated.

Multiple claims against the same notifiable person about the same injury/illness but for different types of compensation will be treated as separate claims and closed under different WINs. For example, a workers compensation claim and a common law claim with the same notifiable person for the same date of injury/illness.

A claim may be terminated at any stage in MCRS. Depending on the claim termination reason, staff may issue a ‘You do not need to tell us’ (Z2797) letter when it is terminated.

Note: confirmation from the other party may be required prior to termination when notification is received that a claim is not proceeding or has not been made. See the:

• Process page for more information
• Resources page for advice on when to request confirmation

Actions that can be taken on a terminated claim include:

• Attach a document which requires no action for example, duplicate or incomplete documents
• Update customer details
• Record a case note
• Resend correspondence
• Unlink documents
• Send stale cheque correspondence

See:

• Process page for how to terminate a claim or attach a document and update details
• Claim management - Medicare Compensation Recovery for how to access or enter case notes
• Medicare Compensation Recovery to resend correspondence
• Process Correspondence - Medicare Compensation Recovery for unlinking documents