Cheque trace requests for patient claims in Medicare 011-43090010

Conduct a security check on the claimant or health professional, see:

• Perform telephone security check for Medicare health professionals
• Authenticating a Medicare customer

Key NHSI,card number,patient,DOS/DDMMYY > [Enter] .

Note: Service Officers must search NHSI using a Medicare card number, not PIN, to view payment information, including cheques.

Check the history to confirm that a cheque has been issued and presented:

• check for payee codes 1,2,4 and 5
• change the control line modifier to DOP/DDMMYY, using the date in the PRC DT field for the service line(s) > [Enter]
• check for any PAYP (payee provider) line above the relevant service line(s)
• once the Service Officer has identified the relevant service press [F10] to view any cheque details

Note: where the payee provider is different than the servicing provider, unpresented cheques sit next to the PAYP line on history.

If the cheque details are:

• Available, note the following:
• cheque number
• date of issue
• cheque amount
• date of processing
• provider number and payee provider if applicable
• date the cheque was presented
• Not available, note the following claim details:
• date of processing
• provider number and payee provider if applicable

Before sending a cheque trace request:

• Log on to Consumer Directory Maintenance System (CDMS)
• Check both the personal and group comments for the patient and claimant to see if the same party has already lodged a trace request for the same cheque

If a previous request has been received from the same party within the last 6-8 weeks but there are no comments in CDMS indicating that a result has been provided by the RBA, it would likely mean that Medicare has not received a response yet. In this instance, a duplicate request is not required.

To complete a cheque trace request form:

• Access the Request for cheque/EFT trace details form. The Resources page contains a link to the form
• Complete and forward the form by email to MPS Assessing

In CDMS under the claimant’s personal details add a comment indicating:

'Cheque trace requested by CLAIMANT/PROVIDER for DOS DDMMYY, PROVIDER NUMBER. Form sent DDMMYY form sent and the date it was sent.'

See also: Amend customer details in the Consumer Directory Maintenance System (CDMS) for Medicare

Key NHSI,card number,patient,DOS/DDMMYY > [Enter]:

• Check that the service details on mainframe match the details on the trace request form
• Determine the claimant by selecting the charge in NHSI and pressing [F1]
• Update the PaNDA naming conventions including the correct Medicare number and name field with the claimant’s full name in the format of:
• SURNAMEFIRSTNAME
• where the claimant and patient are not the same the file should be named as SURNAMEFIRSTNAME of the claimant [space] SURNAMEFIRSTNAME of the patient
• where multiple cheque trace requests have been made for the same claimant for different cheques, add numbers to the end of the claimants name, e.g. the 1st request would be SURNAMEFIRSTNAME, the 2nd request would be SURNAMEFISTNAME2, the 3rd would be SURNAMEFISRTNAME3, and so on

Note: if the cheque is a pay code 5 cheque then only the claimant or patient can request the trace. If the health professional has requested a paycode 5 cheque trace, Medicare cannot proceed with the trace, and contact should be made to advise the health professional.

Check both the patient’s and the claimant’s personal and group CDMS comments to see if a trace has already been requested and/or actioned.

If a previous trace has been requested, locate the file, check to see if the requestor is the same and if Medicare has received a result:

• Same requestor, go to Step 3
• Different requestor, go to Step 4
• Where Medicare has received no previous requests, see Table 3 to determine the status of the cheque

If no result received:

• Record a comment that it is a duplicate request, include the original PaNDA file number, and
• Close the duplicate request

If a result has been received and it has been more than 3 weeks since the result was sent to the requestor:

• Upload documents from the previous request to your PaNDA file
• Resend the cheque trace result to them
• Add note to claimants CDMS personal record
• Finalise the request

If Medicare does not receive a trace result:

• Record a comment that the other party has already lodged a request
• Include the original PaNDA file number and that no result has been received yet
• On the original request, record a comment that a request has been received from the other party and include the PaNDA file number for that new request
• Pend the work item as ‘Previous Work in - Progress Extended’

If Medicare has received a trace result:

• Upload documents from the previous request
• Send the requestor a letter using those details
• Add note to the claimant’s personal comments in CDMS and to the PaNDA file
• Finalise the request

Key NHSI,card number,DOP/DDMMYY > [Enter].

Cheques can be issued for more than one patient if the provider and claimant remain the same. When searching payee code 2 cheques remove the patient name/ card reference from the control line.

Where there is a payee provider, cheque details will not show under the DOS control line.

Note: multiple screenshots of the customer’s information are required to be saved and uploaded to PaNDA as 1 document, including:

• one showing the claimant (press [PF1] on the charge)
• one showing the servicing providers details (press [PF1] on the provider number
• if applicable, one showing the payee providers details (press [PF1] on the provider number)

Press [F10] to determine the status of a cheque. If the cheque is listed as:

• UNPRES - cheque is unpresented and a cheque trace cannot be done. Return the form to the Service Officer to contact the claimant/ health professional
• CAN/EFT - cheque has been cancelled and automatically paid to the health professional under the 90 day scheme
• If the health professional is requesting the trace, order a duplicate 90 day statement. See 90 Day Pay Doctor Cheque Scheme for information about requesting statements. If a 90 day statement is unable to be issued, send them a letter. See Table 8 for more information about Cheque Trace letters
• If the claimant requested the trace, send them a letter. See Table 8 for more information about Cheque Trace letters
• In CDMS under the claimants personal details add a comment stating
  “Cheque trace request received for DOS DDMMYY, $(amount), PROVIDER NUMBER. 90 day statement sent to provider, OR, letter sent to claimant (as applicable). PaNDA ID XXXXXXXXXX”

Note: the comments must include all date of service (DOS) that the cheque was for if it covered multiple DOS as well as both the payee and servicing provider numbers where applicable.

PRES- This means that the cheque has been presented (deposited). Note the cheque number and search for the details in the BBCI screen. Once found, save a screenshot of the BBCI page.

Check the DOP of the claim in NHSI using [SHIFT] + [F2]. It takes approximately 2 weeks after a claim has been processed for a cheque to be issued.

If it has been over 2 weeks from the date of processing (DOP) and there are no cheque details it means the cheque has been presented or it has ‘90 day paid’ and the information has dropped off the system.

Where no cheque details are visible in NHSI, see Table 4.

In Mainframe, key control line RMDS > [Enter]. Key Service Officer’s P number (including the P) as the USERID > [Enter] or key Service Officer’s normal mainframe password (as required):

• In the MAIN MENU screen, key 4 > [Enter]
• On the LIST REPORT NAMES screen press [F8] to scroll to the page with ‘FIN BRU090 CULL RPT-MCA BENEFIT’. On this line, key 3 > [Enter]

Identify the date of processing (DOP) of the cheque and locate the page that has the date 2 months after the DOP , key 1 on this line > [Enter]:

• In the COMMAND = => field, key “f (space) then the Medicare card number minus the last digit” > [Enter]. For example, ‘f 123456789’
• If no results are found “DBNV404 FOR FIND STRING FAILED” will be displayed. Press [F3] to go back to the “LIST REPORT VERSIONS” page and use the down arrow key to go to the next time stamp line, key [F1] & [Enter], and repeat the search
• Repeat the above steps until there is a match
  Note: when searching and the cursor appears towards the right of the screen, Service Officers must press [F11] to go to the next page
• Make sure that the result is for the correct cheque by confirming:
• the amount
• the details in the PROV# field are for the right health professional/ payee provider
• the issue date in the ISS-DT field is after the DOP, and
• that there are no other cheques that issued for the same claimant for the same health professional around the same time
• If the cheque found is not the correct one, press [F5] to continue the search on the same page, and if no others found, [F3] and repeat the search on other time stamps

For cheque status:

• PRES, continue with sending the trace request details to the RBA
• CAN/EFT, order a duplicate 90 day statement if the health professional made the trace request, or send a 90 day letter if the claimant made the request. See Table 8 for more information about cheque trace letters
• CAN (cancelled) or STP (stopped) - no trace can be done. Check NHSI using the date of service (DOS) to see if the claim has been reprocessed to issue a new cheque. If so, perform search for the cheque details. If not, send a letter to the requestor. See Table 8 for more information about cheque trace letters
• Take a screenshot of the RMDS screen showing the correct cheque details, then merge each of the screenshots taken from NHSI and RMDS to 1 document, and attach to the PaNDA file

Open the excel spreadsheet corresponding to the state the cheque was issued. Manually key in the claimant’s surname in the format SURNAME,(SPACE)FIRSTNAME in the Customer Reference No. field, and manually key the 9 digit cheque number in the Cheque No. field.

Note: Service Officers must manually key these details in, not copy and paste them, as the RBA spreadsheets are formatted so that it will not read copy and pasted details.

• Add a note to CDMS stating:
  “Cheque trace request received for DOS DDMMYY, $(amount), PROVIDER NUMBER. Sent to RBA. PaNDA ID XXXXXXXXXX”
• Add a note to the PaNDA file indicating
  ‘Sent to RBA’, then pend the file as ‘Previous work in Progress- Extended’. This will remove the item from the worklist

The spreadsheets for each state are sent:

• at the end of each day
• on separate emails
• by the Service Officer designated for the task
• as advised by their Team Leader

Service Officers must send the spreadsheets from the Provider Services Communication mailbox to RBA cheque traces.

The subject line of the emails should be 'Cheque trace template- (state)', and OFFICIAL must be the security classification.

Move the emails sent to the RBA from sent items to the Templates Sent folder for the relevant month under the ‘cheque traces’ folder in the Provider Services Communication mailbox.

Once the spreadsheets have been emailed, the sender should use the ‘clear contents’ function to remove the request date and all the cheque numbers and claimant names then save the amended document to be reused the following day. Do not clear the Agency Code, BSB or Account No. fields.

The RBA sends responses to the Provider Services Support mailbox and are moved to the Provider Services Communication mailbox by a Team Leader. They are normally located under Folders -> CHEQUE TRACE -> Unprocessed, but may also be in the main inbox.

Note: the designated Service Officer managing the cheque trace emails uploads the RBA responses to the relevant files in PaNDA and changes the status of the files to open. They then unassign the files as ‘User Unavailable’ so they can be reallocated to Service Officers trained in cheque traces to action.

The RBA sends trace responses, bulk requests and control reports.

Bulk Requests Reports are copies of the trace request templates sent, but with the trace reference number added. Once checked, designated Services Officers move these to the appropriate folder:

• If ‘invalid cheque’ should appear alongside a line, confirm the correct details from the PaNDA file and re-enter onto the daily spreadsheet for re-sending

Control reports are also checked, and these generate daily. They will show if a trace request has been sent, completed, or is being followed up

• Upload any reports that show ‘follow up with FI’ (financial institution) or ‘investigation pending’ to the relevant PaNDA file to show why a response may be delayed. Comment in CDMS are not required

Trace Response emails- save the response as a PDF and attach it to the relevant PaNDA file. Add a note saying ‘RBA response uploaded’, then unassign it as ‘User Unavailable’ so that it can be reallocated to Service Officers trained in cheque traces.

The RBA may also send emails regarding the recall of funds where cheques may have been deposited to an account not belonging to the party the cheque was made out to (the payee), where the payee has lodged a cheque trace dispute.

Where they relate to a cheque trace dispute:

• Save the email as a PDF
• Attach it to the related PaNDA file
• Add a note saying ‘RBA response uploaded’
• Unassign it as ‘User Unavailable’ so that it designated Services Officers can reallocate

Where the recall of funds does not relate to a cheque trace dispute:

• Save the email as a PDF
• Upload to PaNDA, Program- Medicare Payments, Work Type- Cheque Trace

See Table 11 for more information about unsolicited return of funds.

When allocated a cheque trace file in PaNDA, that has an RBA response attached, Service Officers must check the cheque details. Check that the serial number on the RBA response, amount and presentation date details match the details on the RMDS/BBCI screenshots previously attached to the file.

Do the response details match the request?

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

Where the details match the request, send an appropriate letter to the requestor. See Table 8 for more information about cheque trace letters.

Once letter has been created:

• Print and upload a copy of the letter to the PaNDA file. Add a note that a letter will be sent to claimant/ provider and that the letter is in quality checking (QC)
• Change the status of the PaNDA file to complete
• Add comments under the claimant’s personal CDMS file stating:
  'RBA response received for DOS DDMMYY, $(amount) PROVIDER NUMBER. Letter sent to provider or claimant (as applicable). PaNDA ID XXXXXXXXXX'

Note: the comments must include all date of service (DOS) that the cheque was for if it covered multiple DOS. It must also include both the payee and servicing provider numbers where applicable.

Submit the printed letter for QC, as per Table 8 Generating cheque trace response letters.

If the response details do not match the request or the screenshots check that the response has been attached to the correct file:

• Check PaNDA for a file matching the response:
• If the response does match a different request, attach the response to the correct file (if not already there) and remove the incorrect response from the file
• Add a note to the file indicating wrong response was originally attached and has been removed
• Check the mailbox for a correct matching response, or ask the designated officer to check for a correct matching response:
• If found, attach it to the correct file and action the trace result
• If not found, add note to the file that the response has not yet been received. Pend the file ‘Previous Work in Progress-Extended’

Cheque details on the response do not match the cheque

If the cheque details on the response do not match the cheque that was to be traced, the Service Officer will need to confirm why the response does not match:

• Check the emailed spreadsheet sent to the RBA for what details were sent, or have the designated person check
• If the incorrect details were sent to the RBA request a new trace for the correct details. Add notes to the file indicating that the incorrect details were originally sent to the RBA so request has been re-sent. Pend the file ‘Previous Work in Progress-Extended’

Service Officers must use approved templates for cheque trace letters. These are available in Operational Blueprint letters and electronic messaging.

The template used will depend on who the requestor is, as what type of letter is being sent:

• Health professional requests - Medicare Provider and Third Party letters, Medicare Claims
• Claimant requests - Medicare Public letters, Medicare claims

There are templates for where the cheque was ‘Paid via 90 days’, where the cheque is unpresented, or for a result of trace for presented cheques, for each type of requestor.

When the requestor is a health professional:

• Cheque trace result letters are sent to the provider location address as per PDS. If there was a Payee provider for the claim, use that provider number to send a letter
• If a Pay Group link is present, address the letter to the health professional using the pay group address, otherwise use the address shown for the provider number

When the requestor is a claimant:

• Address the letter to the claimant using the address in CDMS from Group, not Personal

When the requestor is the health professional:

• Open PDS- Provider Location, and search the provider number. If there was a payee provider for the claim, that provider number should be used for this
• If a pay group link is present, address the letter to the health professional using the pay group address, otherwise use the address shown for the provider number
• Our reference- your source office code/your P number/ PaNDA file ID number
• Customer Type Number- change to ‘Provider number: ‘and add the providers number

When the requestor is the claimant:

• Address the letter to the claimant using the postal address in Group, not Personal
• Our reference- Service Officer source office code/Service Officer P number/PANDA file ID number
• Customer Type Number- change to ‘Medicare Number:’ and add the Medicare card number for the claimant

The presentation details on the letters should be:

• Payee provider- add their title, first name and surname where applicable, or if no Payee provider, add N/A
• Servicing provider- title, first name and surname
• Financial Institution- bank name in full, no abbreviations, no address
• Cheque Number- the cheque serial number from the RBA response
• Cheque amount- amount of the cheque
• Date Cheque Presented- the presentation date from the RBA response

Do not disclose the account name under any circumstances.

Where a cheque has been cancelled, has gone stale, or has been stopped, Service Officers still need to use an approved template. However, it will need to be modified depending on the situation.

If the cheque status is cancelled, or stale and no cheque has been reissued:

• Use the unpresented cheque letter template
• Change the last sentence of the second paragraph to read ‘The current status of the cheque is cancelled/stale’ (whichever applies)
• Change the next paragraph to start with- ‘If you wish to have this cheque reissued…’
  Note: this also applies if the cheque was manually cancelled by Finance as it was stale

If the cheque status is stopped:

• Use the unpresented cheque letter template
• Change the last sentence of the second paragraph to read ‘The current status of the cheque is stopped.’ No other changes to the template are required

Staff to:

• create the relevant work item
• upload a new work item in PaNDA
• select from the dropdown menu:
• Program 'Medicare Payments’
• Work Type 'Cheque Trace’

See Create new work items - PaNDA Document Upload.

Staff must complete the following fields in PaNDA:

• key Medicare number in the Medicare Number field
• key Surname First Name in the Surname First Name field
• key relevant comments in processing notes field in PaNDA and CDMS as per business rules
• select Upload Document
• status as Open

Do not select the Assign to me on creation check box, unless uploading more than one document.

If the quality check outcome is:

• error free:
• staff will not get an email from the quality checker
• the quality checker will print and post the letter to the customer
• error/s identified:
• the quality checker will correct the errors and the letter will be printed and posted to the customer
• the staff member's Team Leader will get feedback via the Staff Feedback Tool
• staff must review the feedback received and refer to the letter in the PaNDA folder (when required)

See Management of the Staff Feedback Tool.

When it has been determined that a cheque has been deposited into an account other than to whom it was made out to (the payee), the payee may contact Medicare to request a third party recall of the funds.

Note: this could include where a claimant has deposited a cheque made out to a health professional. The health professional may request to recall the funds and have the payment reissued. In such situations the provider should be advised to contact the claimant regarding any outstanding monies owed to them, as any reissue of the cheque will be sent to the claimant.

A statutory declaration from the payee of the cheque is required by the RBA and the receiving financial institution before any third party request will be actioned.

These should come from the payee of the cheque:

• If the claim was a pay code 2 - the payee is the health professional so the cheque trace dispute request and the statutory declaration must come from them
• If the claim was a pay code 5 - the payee is the claimant so the request and the Statutory Declaration must come from them
• Statutory declarations should include:
• name of the party making the declaration
• date of the service(s) in question and the items numbers
• health professional’s name (if the claimant is the payee and is making the declaration), and practice address
• amount paid by the claimant
• that a cheque trace was requested and showed that the cheque was presented to a bank the declarer does not have an account with and/or that the funds were not deposited into their account

Note: the statutory declaration should have no personal details such as the patient’s or claimant’s Medicare card numbers or their date of birth (DOB). This is because these are sent outside of the agency and should not have enough personal information that could completely identify the patient.

Cheque trace disputes will come through as new pieces of work in PANDA. If Service Officers are allocated a cheque trace item which is a cheque trace dispute and it:

• Does not include an appropriate statutory declaration, contact the sender and advise them that they will need to submit a new request which includes one. Add a note to the file of the action taken, and change the status to Complete. Procedure ends here
• Does include an appropriate statutory declaration, locate the original trace request in PANDA and upload copies of the original request documents to the trace dispute
• Send an email to Third party recall of funds (Canberra traces) via the Provider Services Communication mailbox with the statutory declaration and the original RBA trace response attached, requesting a recall of funds as the payee has no record of receiving the cheque.
• Save the email as a PDF and upload it to the PaNDA file. Make notes in both CDMS and PaNDA. Pend the PaNDA file as ‘Previous Work in Progress- Extended’

When the RBA receives a dispute, the RBA sends the request to the receiving financial institution who will withdraw the funds from the incorrect account and return it to the RBA.

The RBA will then send an email to Medicare confirming that the funds have been received and credited to Medicare’s master account. To generate a new cheque or payment, the claim will need to be reprocessed:

Check Mainframe to make sure that the original claim has not already been reprocessed:

• If the claim is already reprocessed, go to Step 2
• If the claim in not already reprocessed, go to Step 3

If the RBA has already reversed the claim, the Service Officer should:

• Add comments to PaNDA and CDMS stating:
  ‘Funds returned to Medicare on XX/XX/XXXX of $00.00. DOS, item, Provider No, $00.00. Previously reversed and reprocessed on XX/XX/XXXX. No further action’
• Change the status of the work item to ‘complete’

The Procedure ends here.

If the claim has not already reprocessed and the Service Officer:

• has completed patient claim adjustments training, go to Step 4
• has not completed adjustment training:
• Add comment to the PaNDA file only, stating:
  Funds returned to Medicare on XX/XX/XXXX of $00.00. DOS, item, Provider Number, $00.00. Assigned to C&A TL’
• Pend the PaNDA file and reassign it to the Claims and Assessing Team Leader in Western Australia (WA)
• Email the details to the Claims and Assessing Team Leader in WA with the PaNDA file ID and the patient’s Medicare card number. Advise that the funds have been successfully recalled and request that the claim be reprocessed
• The procedure ends here for Service Officers

The Claims and Assessing Team Leader will assign the work item to a Claims and Assessing Service Officer who will:

• Reverse and reprocess the claim
• Email a ‘Cancel Overpayment Request’ form to the Medicare Debt Recovery Team
• Update comments in PaNDA and CDMS to state:
  'Third party initiated refund. Patient history reversed and reprocessed for DOS xx/xx/xx DOS, item, Provider No, $00.00. PaNDA ID XXXXXXXXXX'
• Once the claim has been reversed and reprocessed, the Claims and Assessing Service Officer should change the status of the work item to ‘complete’

Where a Service Officer is allocated a work item that is a recall of funds that is not related to a cheque trace request:

• The Service Officer must:
• identify the service details (item number, date of service, provider number) relating to the cheque on the patient’s history, and save screenshots
• locate the cheque details on RMDS and save screenshots
• merge all the screenshots and upload them to the PaNDA file

Has the RBA already reversed the claim?

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

If the RBA has already reversed the claim, the Service Officer should:

• Add comments to PaNDA & CDMS stating
  ‘Funds returned to Medicare on XX/XX/XXXX of $00.00. DOS, item, Provider No, $00.00. Previously reversed on XX/XX/XXXX. No further action’
• Change the status of the work item to ‘complete’

Procedure ends here.

If the claim has not already reprocessed and:

• the Service Officer has completed patient claim adjustments training, the Service Officer can go to Step 4
• the Service Officer has not completed adjustment training, the Service Officer must:
• add comments to PaNDA only, stating
  ‘Funds returned to Medicare on XX/XX/XXXX of $00.00. DOS, item, Provider No, $00.00. Assigned to C&A TL’
• reassign the work item in PaNDA to the Claims and Assessing Team Leader in Western Australia

Procedure ends here for Service Officers.

The Claims and Assessing Team Leader will assign the work item to a Claims and Assessing Service Officer who will:

• Reverse and reprocess the claim
• Email a ‘Cancel Overpayment Request’ form to the Medicare Debt Recovery Team
• Update comments in PaNDA and CDMS to state:
  'Third party initiated refund. Patient history reversed for DOS xx/xx/xx DOS, item, Provider No, $00.00. PaNDA ID XXXXXXXXXX'
• Once the claim has been reversed, the Claims and Assessing Service Officer should change the status of the work item to ‘complete’