Medicare claims for deceased persons 011-43010070

Has the executor or appointed administrator provided supporting documentation with the Medicare claim to confirm their identity?

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

Service Officers must check the deceased’s personal comments in CDMS to see if confirmation of identity for the executor or appointed administrator have been previously provided.

Has confirmation already been recorded in CDMS?

• Yes, go to Step 4
• No, go to Step 6

Service Officers must include in the deceased’s personal comment field in CDMS:

• full name of the executor or appointed administrator
• what documents have been sighted or provided, and
• the commencement date

For example, Executor John Citizen certified copy last will and testament DD/MM/YYYY.

Check Safety Net registration for the deceased and make sure they are not listed as the family contact (FC).

See Register for Medicare Safety Net - Families, couples and children for more details.

• Go to the claimant processing screen in Mainframe
• Using the details on the Medicare Claim form (MS014):
• Key NPOI,Medicare number (of the deceased person)
• Press [Enter]. Blank claimant identification fields display
• Key ‘B’ in the CTYPE field
• Key ‘Est of [claimant name]’ followed by a comma in Postal name field. For example, Est of John Citizen,
• Press [Enter]
• Confirm if the claim is paid (Y) or Unpaid (N)
• Press [Enter]
• Update the address to the claimant's correct address supplied on the form
• Complete claim details, see Patient claims processing in Medicare

Procedure ends here.

Service Officers should attempt to phone the administrator or the executor before issuing the Z0828 - Medicare claim needs more information letter.

Tell the administrator or the executor:

• before the claim can be processed, documents are needed to confirm their identity as the administrator or the executor
• the claim will be returned to them with an accompanying letter and that they will need to resubmit the claim with the appropriate documentation

The Resources page contains a link to the Digital Messaging Capability (DMC) to create and send letters.

Service Officers must not process the claim. Send Z0828 - Medicare claim needs more information letter including the approved free text wording:

'We need to update our records before we can process your claim. You will need to submit a new claim with a certified true copy of either the last Will and Testament or the Letter of Administration.'

The Resources page contains a link to the Digital Messaging Capability (DMC) to create and send letters.

See Preparing, quality and peer to peer checking of Medicare external mail.