Process Correspondence - Medicare Compensation Recovery 011-15070000

Where there is:

• an existing claim, assess correspondence received to confirm the details match the claim, including:
• injured person's name, date of birth (DOB) and Medicare card number
• date of injury/illness (DOI)
• description of illness/injury
• WIN - MCRS
• notifiable person's name, address and claim reference number (if known)
• no existing claim, if all mandatory details are:
• provided, register a new active standard claim
• not provided, create a provisional record

See Claim management - Medicare Compensation Recovery for more details.

For work items that contain documents or details:

• about more than one claim, go to Unlink documents or manually separate email correspondence
• attach all documents to the claim, including documents that appear to be an identical copy of items already saved to the claim. These documents may contain additional or different details, including handwritten annotations

For details on how to log on to Mainframe see Table 1 in Medicare Patient History (NHSI) Mainframe.

Use the Medicare national Compensation Recovery Information (NCRI) mainframe screen to check the injured person’s Medicare record for any notes:

In mainframe:

• go to NCRI screen
• key Medicare card number
• [Enter]
• if more than one person is listed on the Medicare card, select the correct customer’s name, [F5]
• [F2] to go to the case notes screen (NCRN). Details of any actions taken since the date of injury or illness will show
• [F8] to move forward if there is more than one page
• [F7] to move backward
• [F2] to return to the NCRI home screen from the case note screen

To find all customers on the same Medicare card:

• go to MCRS
• Check Medicare search
• select, Medicare card hyperlink to view the individual details

Customer's may appear on multiple Medicare cards. This is common with minors. For these cases check the record to find all Medicare cards (including cards that are held in the minor’s name).

On the View Consumer details screen, review:

• Name
• Date of birth
• Date of death
• Medicare card number
• Medicare PIN
• Address:
• current, and
• historical
• Contact Details:
• phone numbers
• email address
• Entitlement, Medicare entitlement details

Use Check Medicare search to view all customers on the same Medicare card and select the Medicare card hyperlink to view the individual details.

Note: search may display more than one result for the same customer. Customers, particularly minors, can be enrolled on more than one Medicare card. Always check the minor's record to ascertain all associated Medicare cards. A minor may also be enrolled on their own Medicare card.

Find Customer Medicare data in View Consumer details using the Medicare number hyperlink in MCRS. Service Officers do not need to access CDMS.

Review details such as:

• Name
• Date of birth
• Date of death
• Medicare card number and Medicare PIN
• Addresses - current and historical
• Contact Details - phone numbers and email address
• Entitlement - Medicare entitlement details

Do the details match the Medicare record (Medicare number, DOB, or address)?

• Yes, go to Step 4
• No, go to Step 3

Make a courtesy call to the injured person/claimant using the details MCRS and complete authentication.

Successful first contact

Where the:

• details submitted on the form do not match agency records and the DOB is verbally confirmed as correct:
• complete all searches to confirm the injured person is eligible for Medicare
• detail all actions taken including the reason for the decision in a case note
• go to Claim Management - Medicare Compensation Recovery
• details submitted on the form do not match agency records and are verbally confirmed as incorrect:
• tell the customer the claim cannot be actioned until correct details are confirmed in writing on a re-submitted form
• register a provisional claim to issue the We need more information to register a compensation claim z2798 letter. See Claim Management - Medicare Compensation Recovery
• Process ends here
• injured person is not eligible for Medicare:
• register an active standard claim using the injured person’s details from the original form
• issue a Notice to Claimant (NTC) to the injured person/claimant. The NTC will only include the care services statement and declaration
• add case notes detail all actions taken including the reason for the decision

Unsuccessful first contact

The claim cannot be actioned, complete the following:

• add case notes detail all actions taken including the reason for the decision
• hold the work item, make a second genuine attempt to contact the injured person/claimant by phone. The second contact attempt must be within 48 hours (not including weekends or public holidays)

Unsuccessful second contact

If unable to make contact for verbal confirmation, the claim cannot be actioned. Complete the following:

• make contact with the sender of the document/s and tell them the documents cannot be actioned
• invalidate the work item
• do not record a case note as the details cannot be confidently matched to a record
• procedure ends here

Where there is a DOB error on the Medicare record, tell the injured person to:

• update their DOB by calling Medicare for minor date updates, for example, one day different. The Resources page has links for contact details
• go to the Services Australia website for details about updating their Medicare record. The Resources page has a link to the website

Review and/or update all relevant compensation claim details.

Select the WIN hyperlink to View compensation details. This can be opened as a pop-up using the icon beside the WIN hyperlink and can be moved around the screen.

Review the following:

• Claim details - including all data on the MCRS screens
• Documents - including all incoming correspondence
• Case notes - including all previous actions taken and decisions made following contact from a customer (incoming correspondence and telephone calls)
• Correspondences - including letters issued
• History - including an audit log of activities taken on the claim

Search SAP to find funds allocated to a WIN, Medicare Card number or 87 number. If payment is found, record the following in case notes:

• Unique insurer number (900)
• Payment amount
• Payment date
• Document number (601)

For multiple payments:

• check for any action needed by Compensation finance before closing the claim
• add case notes, detail all actions needed for claim completion. For example, ‘Completed Referring a claim to Compensation Finance email for combination of funds’, ‘Completed allocation change template for funds to be allocated to WIN’

Review incoming correspondence to determine:

• the documents are complete and valid
• if a letter must be issued

Go to Document Assessment

A previously incomplete form is accepted as valid when re-submitted if:

• all mandatory details are provided, and
• the declaration is re-signed and re-dated

Review all letters for accuracy before issuing:

• select the preview hyperlink, and
• review all details on letter

If details are incorrect:

• do not select Submit
• rectify the errors
• re-submit the letter

There is no option to delete incorrect letters in MCRS once they are issued.

Was the document received signed by the injured person or the claimant/authorised third party?

• Yes, proceed with claim, go to Claim management - Medicare Compensation Recovery
• No, Go to Step 2

Is the injured person's address on the correspondence the same as the details recorded in MCRS view consumer details (Medicare) or View Compensation details screens?

• Yes, the address on the received document and system are the same. Proceed with claim, go to Claim management - Medicare Compensation Recovery
• No, the address is different, or the document is from the compensation payer. Go to Step 3

When correspondence arrives from the compensation payer, and not the claimant/authorised third party complete the following:

• check if the injured person's address has been withheld in historical abuse or psychological injury claims. For all these cases, go to Table 7
• contact the injured person/claimant/authorised third party to confirm correct address details
• make 2 contact attempts on all available contact numbers over 48 hours (not including weekends and public holidays)
• add case notes. Include:
• all actions taken
• details of discussion and advice given

Unsuccessful contact

Leave a voicemail, (even if the customer's name is not identified in the recorded message).The message must include:

• notification the call is from Services Australia and the Service Officer's first name
• the case ID as a reference number. For example, E 123456
• a request for the customer to:
• call Medicare Compensation Recovery (option1)
• use the case ID as reference

Service Officers must:

• add case notes in MCRS listing each contact attempt
• go to Step 4

Successful contact

Where the Service Officer:

• confirms the address on the form:
• update the claim in MCRS
• go to Claim management - Medicare Compensation Recovery
• confirms the address on the form and this is different to the registered Medicare address, tell the injured person/claimant to update their details with Medicare. They can do this by:
• signing in to their myGov account by using my.gov.au and select Medicare online account, for more details, go to Accessing and using Medicare self service
• using the Express Plus Medicare app (make sure the customer is using the latest version), for more details, go to Accessing and using Medicare self service, or
• contacting Medicare general
• cannot confirm the injured persons address, go to Step 4.

Contact the compensation payer/their solicitor and tell them that Medicare Compensation Recovery need to confirm the address of the injured person. Ask them to check their records for any documentation recently signed by the injured person/claimant that confirms their current address. For example, a deed of release or statement of claim.

Can the compensation payer/their solicitor confirm the correct address?

• Yes:
• verbally confirm the type of document and date of signing
• add case notes and include the details of the document
• continue with registration or document processing. Go to Claim management - Medicare Compensation Recovery
• No, go to Step 5

Contact the injured person's solicitor.

• Successful contact:
• give the solicitor their reference number and the injured person's name
• tell them Medicare Compensation Recovery needs to confirm their client's address
• ask the solicitor to tell the client to contact the Medicare Compensation Recovery team to confirm the address
• add case notes and include any actions taken
• Unsuccessful contact: go to Step 7

If the injured person/claimant contacts with the current address:

• process the correspondence using the current address
• tell the injured person/claimant how to update their Medicare general record. Go to Step 2
• add case notes and include any actions taken
• procedure ends here

Compare the address on the submitted document with previous Medicare addresses.

If the address supplied is:

• an historical (outdated) address
• send the correspondence to the latest address registered with Medicare
• add case notes and include any actions taken
• procedure ends here
• not previously recorded, go to Step 8

Check the address of the most recent DOI. Select:

• Medicare card hyperlink to view the Consumer details screen, or
• Consumer Directory Maintenance System (CDMS) for Medicare

If the most recent address is the:

• Consumer details address, use the MCRS address
• DOI address, use the address on the DOI documents

Check all return to sender (RTS) unclaimed mail items for new address details within 24 hours, including:

• Medicare records for any updates. Access a customer's Medicare record by selecting the Medicare hyperlink to access View consumer details and
• MCRS case notes/documents for any documents that are signed by injured person/claimant or authorised third party

For mail received as RTS intended for the notifiable party go to Step 2

If the injured person/claimant/authorised third party has:

• provided updated address:
• resend correspondence to the updated address
• add case notes
• procedure ends here
• not provided updated address and there has been recent contact, go to Step 2
• not provided updated address and there has been no recent contact:
• make 2 reasonable attempts over 24 hours to contact the injured person/claimant/authorised third party
• leave a message notifying the call is from Services Australia and Service Officer's first name. Ask them to call Medicare Compensation Recovery, (option 1)
• add case notes for each attempt

If still unable to contact injured person/claimant/authorised third party after completing all of the above, go to Step 2

Check for previous attempts to contact:

• compensation payer, compensation payer's solicitor or agent
• injured person, claimant or claimant's solicitor (unauthorised)

If there are no contact attempts, try to contact all parties, see Table 2 for more details.

If a current address is provided:

• update the address on the claim and resend correspondence. To stop and re-issue cheques, see Table 5
• add case notes. Include:
• all actions taken
• all details provided by the injured person/claimant
• procedure ends here

If no updated address, go to Step 3

Where an updated address is identified and assessed as the best address to use:

• update the address on the claim and resend correspondence
• add case notes Include:
• all actions taken
• all details provided by the injured person/claimant
• procedure ends here

If no updated address, go to Step 4

When the correct address is not found, turn the RTS mail button On to stop further correspondence issuing.

Select:

• Is update to existing details required? button on the Evaluate screen
• relevant option of Injured person, claimant, notifiable person or notifiable person’s solicitor
• On for the RTS mail button against the address line of the returned mail. This prevents correspondence issuing to that address
• case note - include the following note 'all attempts and assessments have been unsuccessful in finding an updated address'

When issuing correspondence to an address that has the RTS mail button turned On, the correspondence status shows as:

• Error if a correspondence issue attempt is created through a workflow (The ‘Error’ status will not be seen until the system attempts to issue the correspondence)
• Requested copy if resend correspondence is attempted through RCA

When address details are updated, the RTS mail button must be deselected before issuing correspondence.

Examples of duplicate documents include:

• documents that exactly match the initial enquiry case and are attached to the new case, and
• exactly match the details of any documents attached to the case, and
• signed by the same party as the initial documents, and
• signed on the same date as the original documents

The document:

• can come from a different email at a different time or on a different date
• must be identical and have no:
• amendments
• changes
• extra or new details
• further documents attached to the same case

Is the document identical to a previously lodged document?

• Yes, go to Step 2
• No, go to Document Assessment for relevant form requirements table for mandatory details

Duplicate documents are stored in MCRS. Attach all submitted documents to a claim including all duplicates.

To attach a duplicate document:

• select the relevant document type on the Evaluate screen
  For a Statement by Claimant, select Other - all other documents as the document type
• select Is this duplicate correspondence? Button
• select Duplicate
• add case notes. Include all actions taken. Did you add a case note? message shows
• select Yes

The duplicate document can be viewed but will not prompt any further follow-up action.

Fully review the claim making sure all necessary actions are complete.

Service Officers can only unlink documents already attached to a WIN.

If the document is attached to:

• a claim, go to Step 2
• an Enquiry case, go to Table 6

To unlink claim documents:

• Select Restricted Claim Actions from the left sidebar
• Select Search Compensation tab at the top of the screen
• Key the WIN of the claim document
• Select Search. A list of search results shows
• Select Actions, a dropdown menu shows
• Select Unlink documents to remove a document from a claim. A new screen shows listing all documents
• Select the document(s) to unlink
• Select Continue

The Link documents to a WIN screen displays

For a new registration or to invalidate:

• select the Do you want to register a new claim and link the documents? button
• add case notes in the Add comments field. Include all actions taken
• select Continue. The Review Details screen displays. Review the screen for accuracy
• Select Submit to create a new enquiry case for further action

To link to an existing WIN:

• use the search fields to find the correct claim
• key the WIN in the Work Identification Number field
• select Search. An error displays if the WIN entered does not exist
• select the WIN from the results displayed
• add case notes in the Add comments field. Include all actions taken
• select Continue. The comment attaches to the claim that the documents were removed from The Review Details screen displays, review the screen for accuracy
• select Submit. A message displays Keep assigned to me or Assign to queue
• Select:
• Keep assigned to me to action the new work item created, or
• Assign to the queue if not proficient in processing the document type
• Yes

Before attaching to the WIN:

• review each page of the documents:
• confirm which claim(s) they belong to
• Use MCRS to search for the WIN or customer name to make a bundle of documents about each claim
• Name each claim with the correct form or letter code and WIN/customer name
• Save a copy of all documents for each claim, including the email and any cover letters, to the Redaction Working Folder in the shared drive > CompRec > Redaction working folder

Complete the following:

• Delete any entire pages that do not relate to the customer/claim in question using Adobe DC
• Make sure pages t containing mixed customer or claim details are not removed. The unrelated details must be redacted
• Save each document with naming convention WIN Customer Name Form or Letter code', for example, ‘12345678L Sam Citizen MO022'

Remove any details that do not belong to the customer using Adobe Acrobat redaction.

Complete the following:

• Create a clean redacted version of the cover email for each claim removing any reference to multiple claims
• Label the final redacted copy of the document using the naming convention 'WIN Customer Name Form or Letter code redacted'. For example, 12345678L Sam Citizen MO022 redacted'
• Store in the working share drive folder

Attach each new bundle of redacted and cleaned documents (relating to only one claim) to the claim:

• name new bundle with the correct form or letter code, and WIN/customer name. Save a copy of the redacted documents to the Redaction Working Folder in the shared drive > CompRec > Redaction working folder, or
• Attach document/s to an email and send to the Compensation Recovery email address. Do not attach staff names to the email. Senf from the shared inbox using the ‘Send As’ option. For ‘Send As’ access to the shared mailbox, contact your Team Leader, or
• Print the redacted copies and scan to the Compensation Recovery email address using a network Multi-function Device (MFD) set up to send directly to the inbox. Remove all staff member identification or signature blocks and send email as follows:
• To: Medicare Compensation Recovery
• Subject: WIN. For example: 12345678X
• Body: Redacted document cleaned for privacy returned to MCRS for storage. Processing of the documents has already occurred

Invalidate the original Enquiry case so the document bundle is not attached to the incorrect claim, see Table 6 > Step 5 in Mail process and Work Optimiser - Medicare Compensation Recovery.

Each new bundle of documents creates a new enquiry case in MCRS and Work Optimiser.

To access the work, complete a search in MCRS:

• select Restricted Claim Actions from the left side bar
• select the Search Cases tab
• key the WIN into WIN field, or
• email address field (partial email is accepted) with:
• email of the shared inbox or
• MFD email address

To complete:

• action the work item
• after processing, delete the documents from the shared drive

When the injured person's Notice of judgment or settlement (MO022) for a new registration or existing claim does not include the injured person's address, for:

• injuries that include abuse (written as historical or institutional abuse) or psychiatric/psychological injuries, go to Step 2
• other injuries, issue the required letter to ask for the injured person's address, go to Table 8

Check the file when the notice shows the injured persons address as:

• blank or unknown
• c/- injured person/claimant solicitor. When the injured person’s address shows as the solicitor's address, before issuing a Notice to claimant (NTC) check:
• there is a valid Medicare Compensation Recovery Third party authority form (MO021) on the record, and
• this shows the solicitor is an authorised third party

Is there a recent document signed by the injured person/claimant or their authorised solicitor with injured person's address? For example, deed of release, s23A statement

• Yes:
• use that address to register/progress the claim
• procedure ends here
• No, go to Step 3

Call the compensation payer or their solicitor/agent to ask if they have:

• the injured person's current address details, and
• any other identifying details not already provided such as Medicare card number or contact number

Where an address is:

• provided and matches the current or historical address from Medicare records:
• register the claim to the address registered with Medicare
• add case notes
• procedure ends here
• not provided or does not match, go to Step 4

Does the notice of judgment or settlement supply enough detail to identify the injured person such as date of birth and/or Medicare card number?

• Yes, go to Step 5
• No, insufficient identifying details, go to Table 8 to issue a letter

Does the injured person on the notice match a Medicare record?

• Yes, all the details provided match a Medicare record, go to Step 6 to confirm a current address
• No, insufficient identifying details, go to Table 8 to issue required letter

Call the injured person/claimant/authorised third party to get/confirm injured person's current address:

• make 2 reasonable attempts on all available contact numbers
• leave a message notifying the call is from Services Australia and Service Officer's first name. Ask them to
• call Medicare Compensation Recovery, (option 1)
• use the case ID as reference
• add case notes to MCRS for each attempt
• If unable to contact injured person/claimant/authorised third party after these attempts, go to Step 7

Address provided/confirmed and matches Medicare record

• Register a new claim or process existing claim
• add case notes. Include:
• all actions taken
• details of discussion and advice given
• Procedure ends here

Address provided and does not match Medicare record:

If injured person/claimant/authorised third party confirms their current address:

• register new claim or process existing claim
• add case notes
• tell the injured person they can update their Medicare record by:
• signing in to their myGov account by using my.gov.au and select Medicare online account, for more details, go to Accessing and using Medicare self service
• using the Express Plus Medicare app (make sure customer is using latest version), for more details, go to Accessing and using Medicare self service, or
• contacting Medicare
• continue with the claim, do not wait for the Medicare record update
• add case notes. Include:
• all actions taken
• details of discussion and advice given

Contact is unsuccessful, go to Step 7.

If the attempt to contact the injured person is unsuccessful:

• call the injured person or claimant's solicitor
• give the solicitor their reference and the injured person's name
• tell them: ‘Medicare Compensation Recovery needs to confirm your client's address. Please ask your client to contact Medicare Compensation Recovery (option 1) as soon as possible'
• add case notes. Include:
• all actions taken
• details of discussion and advice given
• Go to Step 8

Before making a second contact attempt review case notes for any updates. Where there is a current address recently provided, continue processing with the advised address.

If the current address is not available:

• Go to case notes and make a second contact attempt following the steps that match the previous attempts
• Where the injured person/claimant/authorised third party contacts or returns the call:
• get the address
• register claim or process existing claim
• Where Medicare record is outdated:
• Tell them how to update their Medicare general records,
• Add case notes. Include all actions taken, details of discussion and advice given
• Procedure ends here
• If there is still no confirmed address after completing all the above, go to Step 9

Compare unconfirmed address provided or Medicare record past addresses:

If an address supplied is:

• an historical (outdated) address on Medicare records:
• Register claim or process the existing claim using the latest Medicare address
• Add case notes. Include all actions taken, details of discussion and advice given
• Procedure ends here
• not previously recorded in Medicare records, go to Step 10

Use the most recent address to process the claim:

• If Medicare address date of effect is more recent than the date of injury, use Medicare address
• If date of injury is more recent than the Medicare address date of effect, use address provided
• Add case notes. Include:
• all actions taken
• reasons for accepting the details used

Complete the following if there is:

• an existing claim:
• issue a ‘We are unable to process' (Z2802) letter
• see Claim management – Medicare Compensation Recovery, then go to Step 2
• no existing claim or the claim is provisional:
• issue a ‘We need more information to register' (Z2798)
• See Table 3 in Claim Management - Medicare Compensation Recovery

This steps follows on from Table 1, Step 9 in Claim management - Medicare Compensation Recovery.

To issue a ‘We are unable to process' (Z2802) letter (excluding for a statement by claimant), select:

• Are documents received incomplete? button on the Evaluate screen
• Continue. A message displays Are you sure you want to send correspondence & close Enquiry?
• Yes
• the appropriate form from the dropdown menu
• the relevant reason/s for the inability to complete the form
• the button against the recipient of the letter
• preview hyperlink to view the letter
• Submit to issue the letter

If the MO021 form is invalid:

• the letter is issued to the injured person
• call the third party who submitted the form to tell them it is invalid and cannot be accepted
• for more details, see Authority to access a claim.

To issue the required letter for an incomplete statement by claimant, go to Statement by claimant (SBC) and care costs - Medicare Compensation Recovery.