Process Correspondence - Medicare Compensation Recovery 011-15070000

Service Officers must:

• check inbound correspondence against existing compensation claims to match correspondence to the correct claim. An injured person may have multiple compensation claims in MCRS
• assess correspondence received to confirm if the below information matches an existing claim:
• injured person's name, date of birth (DOB) and Medicare card number
• injury/illness date (DOI) and description
• WIN - MCRS
• notifiable person's name, address and claim reference number (if known)

Otherwise, at first notification:

• register a new claim, if the mandatory information has been provided, or
• create a provisional record if not enough mandatory information has been provided

Go to Claim management: Search, update or register for more details.

If the work item contains documents or information:

• about more than one claim, go to Unlink documents or manually separate email correspondence
• that appears to be an identical copy of what is already saved to the claim, they must be attached to the claim. They may contain additional or different information, including handwritten annotations.

All inbound correspondence is scanned (physical mail), digitised by Kofax and saved in MCRS in the order received and actioned. MCRS is the agency's claim management system for Medicare Compensation Recovery processing. For more details go to Mail process and work optimiser.

Inbound correspondence includes all forms of written communication received by letter, email or fax, such as:

• forms, the Resources page has a link to a list of all forms that may be received
• enquiries, or information provided about the claim or injured person. Go to Enquiries and authenticating a customer and Authority to access a claim as specific rules may apply, for example, to claims involving deceased estates and minors
• supporting documents such as court or tribunal orders, medical practitioner letters, settlement documents

Go to:

• Table 1 on the Process page to determine how to action inbound correspondence
• Process page for detailed instructions on how to assess each form type, including signature and mandatory information requirements

For details of mandatory and additional information requirements for Medicare Compensation Recovery forms, go to Document Assessment - Medicare Compensation Recovery.

If Services Australia receives mail as returned to sender (RTS) because the intended recipient didn't claim it, the RTS button must be turned on. This flags that mail was returned from that address.

The Service Officer actioning the RTS case should then contact the claimant, notifiable person, or their respective solicitors to get the correct information.

Note: the RTS button is an indicator only and will not stop correspondence being issued. Service Officers must deselect the button when the address details are updated and before any further correspondence is issued. This prevents the correspondence presenting with an error.

Go to Table 3 on the Process page.

A Bulk Payment Agreement (BPA) is an agreement between the Chief Executive Medicare and the notifiable person, being the compensation payer or insurer. This is where the notifiable party must pay compensation for claims involved in a class action or multiple claims for the same or similar injury as the result of a known cause. For more details go to:

• Claim Management: Search, Update or Register for details on Bulk Payment Agreements, including the BPA list
• Escalations and case notes for more details on how to escalate the work item to Program Management

Kofax bundles an email and attachments into a single enquiry case and tries to find the relevant WIN. The suggested WIN will flow through to the work item in Work Optimiser, and MCRS will open at the Evaluate screen.

However, Kofax may recognise a string of numbers as a WIN or read numbers incorrectly, so the case may present with an incorrect WIN.

If the suggested WIN is not correct, do not go past the evaluate page, doing so will link the case to the incorrect claim. Service Officers complete thorough checks to make sure the case is being attached to the correct customer and claim (WIN). If the work item has not passed through the Evaluate screen, select the back button to find the correct customer/claim. Attach the case to the correct WIN or register a new WIN if needed.

If the case has already gone through the Evaluate screen and is attached to the incorrect WIN it must be removed. This may involve registering a new claim. To unlink a document from an incorrect WIN and link it to the correct WIN in MCRS, go to Table 5 on the Process page.

If the case contains documents that belong to multiple claims, the case will need manual separation. Each part will contain only information relevant to that claim. Each case must then be re-sent through the mailbox for Kofax to upload into MCRS. Go to Table 6 on the Process page for instructions on separating, redacting, and re-uploading documents.

When there is a mismatch of information between the details submitted and Medicare records, Service Officers may need to issue the relevant missing information letter.

• For existing claims, use the ‘We are unable to process the received form' (Z2802) letter
• For a new claim, register a provisional claim and issue the ‘We need more information to register a compensation claim' (Z2798) letter

Where documentation received for the injured person has a different DOB to Medicare records, complete mandatory checks and confirm it has been correctly matched to the claim/injured person.

Table 1 on the Process page has instructions for confirming the injured person's DOB and updating the Medicare record, if appropriate.

Each new claim registered or processed in MCRS is cross-checked with the injured person's Medicare record to make sure up to date information is used.

Correspondence might be received for a new or existing claim where the injured person or claimant's name on the document does not match the Medicare record. As an example, a family name has changed due to marriage.

A name on the MCRS record should be the same as Medicare. The MCRS record should not be updated until the Medicare record is updated.

An injured person, or other party involved in the claim may contact the agency to query the name on correspondence received. Tell them details on Medicare Compensation Recovery claims are kept the same as Medicare records. If the injured person's name changes, they should update their Medicare record. Tell the customer, that if necessary they can:

• update their legal name over the phone on the Medicare program line if they have their documents with them. The Resources page has a link
• go to the Services Australia Website, Update personal details for Medicare page for more information. The Resources page has a link

If the injured person wants to update their name because of ongoing family and domestic violence, Services Officers can tell them:

• the agency can update the name to any previous name the customer has listed in the Medicare database
• no evidence is needed to return to a previously known by name
• the update will only apply for the purposes of Compensation Recovery
• if they want to update their Medicare records, they need to contact Medicare

The Resources page has a link.

Where documentation has been received from a compensation payer with a different address for the injured person or claimant to that on Medicare, follow the process steps in Table 2 before registering or actioning the document.

The injured person/claimant's address for Compensation Recovery claims can be taken from:

• documents signed by the injured person/claimant including:
• Medicare Compensation Recovery Notice of past benefits request (MO026)
• Commonwealth of Australia Declaration Criminal Code Act 1996 (MO028)
• Medicare Compensation Recovery Section 23A statement (MO023)
• Medicare Compensation Recovery Bank account details collection (MO024)
• Deed of Release documents only if signed by the injured person/claimant
• documents signed by their authorised third party
• authenticated inbound or outbound telephony with the injured person/claimant or their authorised third party
• Medicare record of the injured person:
• where the Medicare address is different to that on compensation payer documents received, follow Table 2 during document assessment. Confirm a correct address before claim registration or processing the correspondence received. This is to avoid privacy breaches

Note:

• Where both postal and residential addresses are provided concurrently, use the nominated postal address
• Where the agency receives Return to Sender mail, subsequent correspondence cannot be issued for the same individual at that address. Some other confirmation of that address would have to be provided, such as a declaration recently signed and dated by the injured person.

For an abuse or psychological injury claim, the compensation payer may not have all the injured person's details, such as an address.

Where the agency is first notified of such a claim by a notice of judgment or settlement, follow the process steps in Table 7 to match the notice to the correct person's Medicare record.