Escalation process for Medicare Eligibility 011-44015000

A Service Officer must try to resolve a customer enquiry at first point of contact by using all resources available before contacting Local Peer Support (LPS).

All vulnerable customer enquiries must be processed at first point of contact. Service Officers not skilled in this work type, must escalate to LPS for help.

The Process page contains steps a Service Officer must follow before contacting LPS.

If Service Officers cannot resolve the enquiry, escalate to Medicare and Aged Care - LPS.

LPS will give a:

• verbal answer to verbal enquiries, or
• request Service Officers to escalate the enquiry through PaNDA, include any investigations, notes, and documents

Service Officers and HSDD Service Officers must not escalate any enquiries to the Medicare Consumers Program Support Team directly. Only LPS have the delegation to do this.

Service Officers not skill tagged in family and domestic violence (FDV) must recategorise all applications received to copy or transfer a child under 15 years of age due to FDV to ME_FDV. Service Officers skill tagged in FDV will assess these applications.

If:

• a request is received and a customer is concerned about their immediate wellbeing or safety, Service Officers must contact Local Peer Support (LPS)
• LPS decide if immediate attention is required, LPS must email Health Service Delivery Division for advice

Identification documents need to be verified in the Document Verification System (DVS) before processing enrolment applications.

The Medicare Consumers Program Support Team help with complex Medicare enrolment/eligibility and CDMS Medicare Safety Net (MSN) requests and enquiries. This includes, but is not limited to:

• providing an accurate interpretation of enrolment and eligibility policies to help resolve a customer’s eligibility
• considering all relevant legislative and policy requirements which can be used to undertake further assessment of a customer’s individual circumstances. A final decision is then made that matches the policy intent
• supporting various internal and external stakeholders to ensure that the Medicare programme is implemented to align with legislation, existing policy, and processes
• escalated unresolved DVS code D results

In most cases the Medicare Consumers Program Support Team does not contact the customer unless it is required.