Medicare Safety Net letters 011-43080110

Verified payments occur when a:

• customer pays for their health service in full before a Medicare claim is submitted, and
• Medicare benefit is paid to the claimant

As the health professional's account was paid in full, it is considered a verified payment. The out-of-pocket expense and gap amount counts toward the MSN threshold.

Unverified payments occur when a:

• customer does not pay for their health service in full (unpaid or partially paid) before a Medicare claim is submitted, and
• Medicare benefit is paid to the health professional

When this happens, the out-of-pocket expenses and gap amounts are unverified and do not yet count toward the MSN threshold. Once the remaining balance of the health service is paid in full to the health professional:

• the claimant can provide a receipt to Medicare, and
• Service Officers can verify the service

The verified payment then counts the out-of-pocket expenses and gap amount toward the MSN threshold.

See Verify services for Medicare Safety Net.

Letter A is a system generated letter:

• sent to customers who are not in a registered MSN family
• sent when:
• a patient claim is processed, and
• the customer's combined verified and unverified out-of-pocket expenses are nearing the MSN threshold
• that lists all services with unverified payments recorded for the customer for the relevant calendar year

The letter informs the customer:

• they are close to a MSN threshold
• there are services on their Medicare claims history requiring verification that may take them over the threshold. This may qualify them for MSN benefits for the relevant calendar year

The letter is sent to the customers mailing preference:

• myGov Inbox, or
• postal address recorded in CDMS

The system only generates Letter A for the current and previous calendar years.

Letter B is a system generated letter:

• sent to customers who are not in a registered MSN family
• sent when:
• a patient claim is processed, and
• the customer's verified out-of-pocket expenses exceed the MSN threshold
• lists all services with unverified payments recorded for the customer for the relevant calendar year

The letter informs the customer they have reached or exceeded the MSN threshold for the relevant calendar year. It gives the customer an opportunity to see their unverified payments, which when verified could be eligible for MSN benefits.

The letter is sent to the customers mailing preference:

• myGov Inbox, or
• postal address recorded in CDMS

The system only generates Letter B for the current and previous calendar years.

Letter F is a system generated letter sent:

• to the family contact (FC) of a registered MSN family
• when:
• a patient claim is processed, and
• the family's combined total of verified and unverified out-of-pocket expenses reaches 70% (or above) of the MSN threshold

The letter informs the FC:

• that the registered MSN family is close to the MSN threshold for the relevant calendar year, and
• confirmation of the members of their family is required before MSN benefits can be paid

If the FC mailing preference is myGov Inbox, a notification is sent to their myGov advising they have a Medicare online account (MOA) MSN confirmation task. This includes a link that prompts the FC to confirm their family. There is no digital letter that is visible or sent to the FC. Otherwise, the letter is posted to the address recorded in CDMS.

The system only generates Letter F for the current and previous calendar years.

Letter U, also known as an unverified payments letter, is a manually generated letter:

• requested by Service Officers in CDMS
• sent to:
• members of a registered MSN family, or
• customers not in an MSN family
• that lists all services with unverified payments for the relevant calendar year

The letter contains details about unverified payments for Medicare claims made on any Medicare card the customer is associated with, within the requested calendar year. This is because the letter is Medicare PIN based.

The only exception is if the request relates to a child under 14 years. See below, for details about Requesting Letter U for a member under 14 years.

If there are no unverified payments recorded for a customer, the Letter U cannot be issued.

The letter is sent to the customers mailing preference:

• myGov Inbox, or
• postal address recorded in CDMS

Customers can also access this information by requesting an Unverified Payment Statement through their Medicare online account. See Unverified Payment Statement via Medicare online accounts.

Requesting Letter U for a member 14 years or older

Any member of a registered MSN family 14 years or older, can request a letter for:

• themselves, and/or
• other members of the registered MSN family who are 14 years or older

If a Letter U is requested for another member of their MSN family, the letter is addressed and issued to the member that the unverified payments relate to.

Requesting Letter U for a member under 14 years

Only the family contact (FC) or spouse/de facto partner (SP) of the registered MSN family can request a Letter U for a child dependent under 14 years. Service Officers must authenticate the customer requesting the Letter U and verify that the requester is:

• associated to the same Medicare card as the child, and
• an FC or SP on the registered MSN family

If a child is registered on more than one Medicare card, only unverified payments recorded against the Medicare number of the requester are listed. This makes sure the child's:

• privacy is not breached, and
• services claimed against another Medicare card are not listed

The letter will be addressed and issued to the FC or SP who requested the letter.

If the requester and the dependent child are not on the same Medicare card, see Release of information for Medicare.

Customers can view and print an Unverified Payment Statement via their Medicare online account for the current or previous calendar year.

Unverified payments are when an individual or a member of the registered MSN family does not pay the health professionals fee before making a patient claim. The Unverified Payment Statement lists all unverified payments for an individual or a registered MSN family member.

The family contact (FC) or spouse/de facto partner (SP) of a registered MSN family can access a dependent child's unverified payment information if:

• the dependent child is under 14 years, and
• associated on the Medicare card number used to log into their Medicare online account

Unverified Payment Statements do not show for anyone between 14-17 years. For these customers, the FC or SP must request a Letter U.

Due to privacy requirements, a request must be made to the agency’s Information Release Section if the request is:

• for a customer 14 years or over, and
• made by someone other than the customer, and
• for information to be sent to the requesting person. For example, a third party

or

• for a child under 14 years, and
• made by a parent or guardian on the same Medicare card who is not registered as part of the MSN family with the child, or
• made by someone who is part of the registered MSN family but not on the same Medicare card

A request for MSN letters cannot be made for a person who has a Date of Death recorded in CDMS.

The details of MSN letters are recorded in the Inquiry Medicare Safety Net Details screens in CDMS for customer enquiry and audit purposes if the letter is either:

• requested via CDMS, or
• automatically generated through patient claiming

Service Officers can view these details under the Letters Details tab in CDMS.