Process Correspondence - Medicare Compensation Recovery 011-15070000

Review the injured person's details on the Medicare record.

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.

Select the Medicare card hyperlink to display View Consumer details screen. 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

After checking the injured person's details, can they be confidently matched to a Medicare record, such as by the Medicare number, DOB, or address?

• Yes, go to Step 3
• No, go to Step 2

Note: customer Medicare data is available in View Consumer details using the Medicare number hyperlink in MCRS. Service Officers do not need to access CDMS.

Make a courtesy call to the injured person and confirm:

• The details submitted on the form do not match agency records. If DOB is verbally confirmed as correct, confirm if the injured person is eligible for Medicare. Complete all searches to confirm
• Go to Claim Management: Search, update or register
• If the injured person is not eligible for Medicare, register a provisional WIN. The declaration date button must be left turned off. Issue the ‘Compensation claim cannot be registered' (Z2797) letter to the sender of the received correspondence
• Go to Notifiable and not notifiable claims
• If unable to make contact for verbal confirmation, register a provisional WIN and issue a ‘We need more information to register a compensation claim' (Z2798) letter and select that details don't match agency records
• Go to Claim Management: Search, update or register
• Case note the actions taken and the reason. Terminate the claim, selecting not notifiable as the closed reason.
• Go to Close, terminate, update or reopen a claim

Note: if an error is identified 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
• going to the Services Australia website for information about how to update their Medicare details. The Resources page has a link to the website

Review and/or update all relevant compensation claim information.

Select the WIN hyperlink to View compensation details. Review information using the below tabs:

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

Note: the View compensation details screen can be opened as a pop-up using the icon beside the WIN hyperlink. This lets the pop-up be moved around the screen.

To identify if any payments have been received, search SAP to find funds allocated to a WIN, Medicare Card number or 87 number.

If payment is found, record the below details in case notes:

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

Note: if multiple payments are received, action may be needed by Compensation finance before the claim can be closed.

Review the incoming correspondence to determine if the form or documents received are complete and valid or if a letter needs to be issued.

Go to Document Assessment

Note: when an injured person amends and re-submits a form that was previously incomplete, it can be accepted as valid when:

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

Review all letters for accuracy before issuing by:

• Selecting the preview hyperlink, and
• Reviewing the details on letter
• If information is incorrect, do not select Submit until errors are rectified

Note: MCRS does not have the function to delete incorrect letters once issued.

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

• Yes, proceed with claim, go to Claim Management: Search, update or register
• 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: Search, update or register
• No, the address is different, or the document is from the compensation payer. Go to Step 3

If the correspondence arrives from the compensation payer, and not the claimant/authorised third party, the Service Officer must:

• contact the injured person/claimant/authorised third party to confirm correct address details
• make 2 contact attempts over 48 hours on all available contact numbers
• if contact is unsuccessful, a voicemail can be left asking for return contact, provided the injured person/claimant identifies themselves. Service Officers must leave a case note advising of each attempt in MCRS

If the address provided on the form is confirmed as correct, update the claim in MCRS and continue.

Go to Claim Management: Search, update or register

• If the address is different to that registered with Medicare, tell the injured person/claimant to update their details with Medicare. Tell them 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 Using Medicare self service
• using the Express Plus Medicare app (make sure the customer is using the latest version), for more details, go to Using Medicare self service, or
• tell them to contact Medicare general
• add a case note

Note:

• Always authenticate a customer before giving out any information about a claim, for more details, go to Enquiries and authenticating a customer
• Go to Table 7 where an injured person's address has been withheld in historical abuse or psychological injury claims

If contact with the injured person, claimant or authorised third party is not successful in confirming the injured person's address, go to step 4

Tell the compensation payer/their solicitor:

• Medicare Compensation Recovery needs to confirm the address of the injured person
• Ask if they can check their records for documentation recently signed by the injured person/claimant which confirms their current address. For example, a deed of release or statement of claim
• Yes, verbally confirm the type of document signed and ask the date of signing, record this information in case notes. Once confirmed proceed with registration or document processing. Go to Claim Management: Search, update or register
• No, go to Step 5

If contact is successful

• Provide the solicitor with their reference and the injured person's name
• Tell them Medicare Compensation Recovery needs to confirm their client's address
• Ask for the client to contact the Medicare Compensation Recovery team to confirm the address, enter case notes

If the injured person/claimant contacts the agency and advises of current address:

• use the provided address to process the correspondence:
• Tell the injured person/claimant how to update their Medicare general record, go to Step 2
• Enter case notes
• Procedure ends here

If contact is unsuccessful, go to Step 6.

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

If the address supplied is:

• a historical (outdated) address
• process correspondence to the latest address registered with Medicare
• enter case notes
• procedure ends here
• not previously recorded, go to Step 7

Use the most recent address to process the claim if:

• MCRS address date of effect is more recent than DOI, use MCRS address
• DOI is more recent than that of MCRS, use the address on documents

• Complete Steps 1 and 2 within 24 hours
• Check Medicare record for updates and MCRS case notes/documents received that are signed by injured person/claimant or authorised third party:
• If the injured person/claimant/authorised third party has provided updated address resend correspondence to the updated address. Enter case notes. Procedure ends here
• No updated address, read Recent contact below

Recent contact

• If a recent attempt was made to contact the injured person/claimant and/or authorised third party, go to Step 2
• If no recent contact:
• make 2 reasonable attempts over 24 hrs to contact the injured person/claimant/authorised third party
• case note each attempt and leave a message on voice mail if injured person/claimant identifies themselves
• If unable to contact injured person/claimant/authorised third party, go to Step 2

Note: access a customer's Medicare record by selecting the Medicare hyperlink to access View consumer details.

Check for previous attempts to contact:

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

If no contact attempts have been made, try to contact all parties, Table 2 has more details on contacting.

If updated address is provided:

• update the address on the claim and resend correspondence
• enter case notes
• procedure ends here

If no updated address, go to Step 3

Table 2 has details to assess the best address to use.

If updated address is identified:

• update the address on the claim and resend correspondence
• enter case notes
• procedure ends here

If there is no updated address, go to Step 4

• Turn MCRS button on for RTS address so the claim shows the correct information
  Note: the RTS button is an indicator only and will not stop correspondence being issued
• Add a case note that all attempts and assessments have been unsuccessful
• Go to Table 8 to issue a letter

Note: deselect the RTS button when address details are updated and before issuing any further correspondence . This prevents the correspondence presenting with an error.

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 information

Duplicate documents are stored in MCRS. Attach all submitted documents to a claim, even if they are duplicates.

To attach a duplicate document:

• select the relevant document type on the Evaluate screen
  Note: if the document is a Statement by Claimant, select Other - all other documents as the document type
• select the is this duplicate correspondence? Button
• select Duplicate
• add a case note
• Did you add a case note? Message displays
• select Yes

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

Note: complete a full assessment of the claim to make sure all necessary actions have been taken.

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

• Select Restricted Claim Actions from the left sidebar
• Select Search Compensation tab at the top of the screen
• Key the WIN which the document is attached to, then select Search

A list of search results will show on screen.

Select:

• Actions, a dropdown menu appears
• Unlink documents to remove a document from a claim

A new screen displays listing all documents.

Select:

• the document(s) that require(s) unlinking
• Continue

The Link documents to a WIN screen displays

For a new registration or if invalidation is needed:

• select the Do you want to register a new claim and link the documents? button
• enter a case note in the Add comments field. Select Continue
• the Review Details screen displays. Review the screen for accuracy and 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 and select Search
  Note: an error displays if the WIN entered does not exist
• select the WIN from the results displayed
• enter a case note in the Add comments field then select Continue
• the Review Details screen displays, review the screen for accuracy and 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

• Review each page of the documents and confirm which claim(s) they belong to:
• Use MCRS to search for the WIN or customer name so a bundle of documents about each claim can be made
• 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:
• Name each one with the correct form or letter code and WIN/customer name

• Use Adobe DC to delete any entire pages that do not relate to the customer/claim in question
• Make sure pages that contain mixed customer or claim information are not removed as the unrelated information will be redacted

Save each document with naming convention WIN Customer Name Form or Letter code', for example, ‘12345678L Sam Citizen MO022'

Remove any information that does not belong to the customer using Adobe DC redaction.

The cover email in particular may contain reference to multiple claims and a clean, redacted version for each claim is needed.

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.

Each new bundle of redacted and cleaned documents (relating to only one claim) must be attached to an email and sent back to MCRS.

Send email:

• To: Medicare Compensation Recovery (the Resources page has a link to email address)
• Subject: WIN/Name Form or Letter code (for example: MO022, if available)
• 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.

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

• To access the work, complete a search in MCRS and action as required
• Delete the documents from the share drive once work has been processed

A Notice of judgment or settlement (MO022) received for claim registration without the injured person's address.

For:

• injuries such as abuse or psychological, continue this workflow
• other injuries, issue the required letter to get the injured person's address, go to Table 8

Notice indicates injured person address as:

• blank or unknown
• c/- claimant solicitor

Do we have 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 2

Call the compensation payer or their solicitor/agent to:

• confirm they do not have the injured person's address details, and
• ask if they have any other identifying information not already provided such as Medicare card number or contact number

Where address matches the current or historical address from Medicare records:

• register the claim to the address registered with Medicare
• add a case note
• procedure ends here

Where no address is provided, go to Step 3

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

• Yes, go to Step 4
• 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 5 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 contact attempts on all available contact numbers
• Leave message on voicemail if injured person/claimant identifies themselves
• If unable to contact injured person/claimant/authorised third party on first attempt, go to Step 6
• Add a case note

Address is provided/confirmed that matches Medicare record

• Register claim and enter case notes
• Procedure ends here

Address is provided that does not match Medicare record:

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

• Register claim and enter case notes
• Tell them that 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 information, go to Using Medicare self service
• using the Express Plus Medicare app (make sure customer is using latest version), for more information, go to Using Medicare self service, or
• telling them to contact Medicare
• procedure ends here

If contact is unsuccessful, go to Step 6.

• 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 us as soon as possible on 132 127'
• Add a case note
• Go to Step 7

• Review case notes for any updates and process with advised address or make a second attempt to contact parties as per previous attempt. Go to the step that matches what has been attempted as per the case notes
• If contacted by injured person/claimant/authorised third party:
• get address and register case
• If Medicare record is outdated:
• Tell them how to update their Medicare general records, go to Step 5
• Enter case notes
• Procedure ends here
• If no confirmed address, go to Step 8

Compare unconfirmed address provided or Medicare record past addresses:

If an address supplied is:

• a historical (outdated) address on Medicare records:
• Register claim to the latest Medicare address
• Enter case notes
• Procedure ends here
• not previously recorded in Medicare records, go to Step 9

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
• Enter case notes

If any information is missing, issue either of the following letters:

• ‘We need more information to register' (Z2798) if there is no existing claim or claim is provisional. Go to Table 3 in Claim Management: Search, update or register
• ‘We are unable to process' (Z2802) if there is an existing claim go to Step 2

This steps follows on from Table 1, Step 9 in Claim Management: Search, update or register.

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

• Select the Are documents received incomplete? button on the Evaluate screen
• Select Continue
• Message displays Are you sure you want to send correspondence & close Enquiry?, select Yes
• Select the form that we are unable to process from the dropdown menu
• Select the relevant reason/s the form is incomplete
• Select the button against the recipient of the letter
• Select the preview hyperlink to view the letter
• Select Submit to issue the letter

Note: 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 information, go to 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.