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.

The Process page contains details about correspondence checks.

A suite of systems captures and organises all correspondence received by email. Using these details the system creates, prioritises and allocates work items for staff to process in MCRS.

For more details see:

• Mail process and work optimiser
• Medicare Compensation Recovery System (MCRS)
• Workload Management

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

• forms, the Resources page has a link to a list of all forms
• enquiries, or information provided about the claim or injured person. Specific rules may apply, for example, claims involving deceased estates and minors. For more details, see:
• Enquiries and authenticating a customer
• Authority to access a claim
• supporting documents, for example:
• court or tribunal orders
• medical practitioner letters
• settlement documents

For details on assessing each form type including mandatory information, see Document Assessment - Medicare Compensation Recovery.

The Process page contains details on how to action inbound correspondence.

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

The Process page contains details on how to action unclaimed mail sent to Services Australia as returned to sender (RTS).

A Bulk Payment Agreement (BPA) is an agreement between the Chief Executive Medicare and a notifiable person, being the compensation payer or insurer, as outlined under Section 34 of the Health and Other Services (Compensation) Act 1995 (the Act). After making an agreement, the notifiable party must pay an agreed amount to Medicare for each claim settled. For more details on:

• Bulk Payment Agreements, including the BPA list, see Claim management - Medicare Compensation Recovery
• escalating the work item to Program Support Officers, Service Delivery APS5 or Program Management, see Escalations - Medicare Compensation Recovery

Kofax matches email attachments to a corresponding WIN number to create the work item in Work Optimiser. In some instances, the WIN number may not be correct.

MCRS will open at the Evaluate screen. To avoid linking the case to the incorrect claim, Service Officers must:

• not go past the evaluate page
• complete a thorough investigation and confirm the case is connected to the correct customer and claim or WIN

The Process page contains the correct process to follow for:

• unlinking a document from an incorrect WIN and linking it to the correct WIN in MCRS
• separating, redacting, and re-uploading documents when the documents belong to multiple claims

When there is a mismatch between the details submitted and Medicare records, contact the injured person to confirm the correct details. If the contact attempt is unsuccessful, send a missing information letter. The Process page contains more details.

Where the injured persons claim documentation has a different DOB to Medicare records, confirm the match is correct by completing all mandatory checks.

The Process page contains instructions for confirming the injured person's DOB and updating the claim.

Service Officers must cross-check each new claim registered or processed in MCRS, with the injured person's Medicare record to confirm the details are up to date.

In some cases, the injured person or claimant's name on the claim correspondence will not match the Medicare record, for example, a family name has changed due to marriage.

The name on the MCRS record:

• must match the Medicare record
• must not be changed until the Medicare record is updated

Details on Medicare Compensation Recovery claims are the same as the details on Medicare records. If the injured person's name changes, tell them to update their Medicare record. The Resources page contains links to Services Australia Website:

• Phone us - to update a legal name over the phone on the Medicare program line when all documents are available
• Email us - to update personal details for Medicare

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

• agency can update the name to any previous name the customer has listed in the Medicare database. They do not need any evidence for this type of update
• this type of update will apply to Medicare Compensation Recovery only. They must contact Medicare to update Medicare records

The Resources page has a link.

A compensation payer may provide documents with a different address to the injured person or claimants Medicare record. Before registering or actioning the document, follow the process steps in Table 2.

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 Third party authority (MO021)
• Medicare Compensation Recovery Notice of past benefits request (MO026)
• z2801 Declaration, issued with the Notice to claimant (NTC)
• Medicare Compensation Recovery Section 23A statement (MO023)
• Medicare Compensation Recovery Bank account details collection (MO024)
• Judgement/Settlement supporting documents, signed by the injured person/claimant. For example, Deed of Release documents
• documents signed by the injured person's 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.
• To avoid a privacy breach, confirm a correct address before claim registration or processing of correspondence

For cases where:

• both postal and residential addresses are provided concurrently, use the nominated postal address
• the agency receives Return to Sender mail, subsequent correspondence cannot be issued for the same individual at that address. Additional confirmation of that address must 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.

If a Medicare Compensation Recovery notice of judgment or settlement form is used as notification, follow the process steps in Table 7 to match the notice to the correct person's Medicare record.