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Extended Medicare Safety Net (EMSN) - concessional threshold 011-43080010

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This document outlines the EMSN Concessional threshold for Medicare. It provides eligibility requirements for the EMSN Concessional threshold for individuals, registered Medicare Safety Net (MSN) families, and details MSN benefits payable when the EMSN Concessional threshold is met.

On this page:

Checking EMSN Concessional eligibility in CDMS

Checking Pharmaceutical Benefits Scheme (PBS) screens for enquiries about a customer’s concessional status

CDMS does not reflect the EMSN Concessional eligibility

Checking EMSN Concessional eligibility in CDMS

Table 1: this table describes how to display a customer's EMSN Concessional status in CDMS.

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Step

Action

1

Identify and authenticate the customer

See Authenticating a Medicare customer.

2

Log into CDMS

Log into the Consumer Directory Maintenance System (CDMS).

Select Inquire on Consumer Details.

3

Select Medicare Safety Net Inquiry Search
  • Select Medicare Safety Net from the Program drop down list
  • In the ID Number, key in the customers:
    • Medicare Card number
    • Consumer ID, or
    • Medicare Personal Identification Number (PIN)
  • Select the matching ID Number Type (Medicare card number, consumer ID or Medicare pin) from the drop down list
  • Select the relevant Medicare Safety Net year from the drop down list
  • Select the Entitlement button

Note: if the consumer’s details (name, date of birth etc.) are used to search for a person and an exact match is not found, the system will display a list of possibilities.

See Register a customer for Medicare in the Consumer Directory Maintenance System (CDMS).

4

Select customer

Select the radio button next to the individual the inquiry is for.

Select the Continue button.

5

Threshold details for families

The Inquiry Medicare Safety Net Details page will be displayed.

If the individual is eligible for the EMSN Concessional threshold, Concessional displays in the threshold type.


Checking Pharmaceutical Benefits Scheme (PBS) screens for enquiries about a customer’s concessional status

Table 2: this table describes how to display a customer’s concessional status using the RPQN enquiry screen.

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Step

Action

1

Entering patients details

Key the patient's details on the RPQN screen. If the patients' concession number is:

  • known:
    • Key this in the entitlement ID
    • Press F9-ELIGIBILITY DETAILS
  • unknown:
    • Key the patient’s surname, first name and date of birth. Press [Enter]
    • Press [F9] - ELIGIBILITY DETAILS
  • more than one person comes up on the concession screen:
    • Key the number next to the person
    • Press [F9] - ELIGIBILITY DETAILS

Note: if Service Officers need to search the previous calendar year’s history, add ‘H’ to the Search File field, this will display the patient history.

2

Checking concessional status

If the patient is concessional, conc will appear in the level code column.

On the row where conc appears, check the concessional reason code under the ENT DESC column.

Check if the concession card type entitles provider to claim Centrelink:

  • Commonwealth Seniors Health Card (CSHC)
  • Health Care Card (HCC)
  • Pensioner Concession Card (PCC)

Note: Gold or White Cards issued by DVA do not provide eligibility for the EMSN Concessional threshold. However, if a Gold or White Card holder also holds a recognised Commonwealth concession card and chooses to be treated under Medicare arrangements, they are eligible for the EMSN Concessional threshold.


CDMS does not reflect the EMSN Concessional eligibility

Table 3: describes the steps to take when the system does not reflect the concessional status as stated by the customer.

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Step

Action

1

Complete a Medicare Safety Net escalation form

If the customer’s CDMS record does not reflect their EMSN Concessional threshold eligibility, complete a Medicare Safety Net escalation form on the Resources page, and advise the customer the enquiry will be escalated.

Supply the following information to assist with the query:

  • Service Officer's details:
    • Name
    • logon ID
  • customer details:
    • customer name
    • Medicare card number
    • Medicare Safety Net year of enquiry
  • customer reference number (CRN) and/or reference number
  • PaNDA ID (where applicable)
  • any additional information to assist with the query

Complete the form in full and email to Medicare Consumers Program Support.

Put a note in CDMS and PaNDA indicating an MSN escalation form has been sent for safety net year 20XX.

Note: incomplete forms or forms missing information will be returned to Service Officers to complete.