Purpose

This Departmental Instruction is to advise of enhancements that will be introduced to further automate processing of Claims Management System (CMS) and Death Processing System (DPS) actions for Commonwealth Seniors Health Card holders.

Background

A Stateline was circulated in September 2001 which described the introduction of system changes to facilitate the processing of CSHC claims.  That Stateline indicated that further enhancements were being made to the system to further automate CMS and DPS processing capabilities.

Implementation Date

The enhancements to CMS and DPS will be introduced during the week commencing Monday 10 December 2001.  Contact officers for the CSHC project will be informed when the promotions are made.

Attachments

There are two attachments which describe the CMS and DPS processing changes.

Contact Officer

Any questions regarding these changes should be directed to David Owen by e-mail or phone (02 6289 6685).

Introduction

This attachment outlines the changes to the way CMS actions will be processed for CSHC claims.

Current Processing

Currently the recording of, and all changes to, a “Senior's Card” registration are totally manual .

The following table provides the steps that are currently required.

Step

Action

1

Register a CMS case via CM.CI screen in “Await Prepare Record” stage.

2

Update case attributes via CM.UA.  Note either of the mandatory attributes; “Successful claim” or “Unsuccessful Claim”, must be set.

3

Update the stage via CM.SC screen.

If the stage is progressed to:

1. “Prepare Recording” then move to Step 4.
2. “Case Finalisation” then move to Step 5.
3. “Case Withdrawn” Then move to Step 6.

4

Update the stage from “Prepare Recording” via CM.SC screen.  Note that the stage can only be progressed back to “Await Prepare Record”.

5

The case if now finalised and will be included in the appropriate CMS reports.

6

The case has been withdrawn.

Changes

There is currently no interaction between CMS and the new CSHC recording facility in VIEW.  The enhancements to be introduced will provide automatic case progression functionality as a part of the VIEW recording process.

New Processing

Following the introduction of the enhanced functionality there will be two options with regard to CMS actions.  These two options are:

• Manually registering a case via CM.CI in “Await Prepare Record” stage.
• No manual interaction at all.

If a CMS action ...

... been manually created then when the CSHC eligibility is recorded in VIEW...

has

•     the attribute will be automatically updated according to the claim's success.
•     the stage will be automatically progressed to “Case Finalised”.

has not

•     a “Senior's Card” action will be automatically created with a receipt date equal to the date of processing.
•     the attribute will be automatically updated according to the claim's success.  Eg.  if the CSHC eligibility is recorded as “On” then the mandatory attribute, “Successful Claim”, will be set to “Y”

• the stage will be automatically progressed to “Case Finalised”.

Points to note

There are several points to note regarding then new functionality:

• If a case is manually created then it can still be withdrawn if required.
• If a case is automatically created the CMS reporting will not reflect the correct time taken to process and, therefore, it is still preferable to manually register the claim upon receipt.

Introduction

This attachment outlines the changes to the way DPS actions will be processed for CSHC holder who die.

Current Processing

Currently the CSHC eligibility is only recorded in the database as a “SHC” BELI type.  The recording of a date of death (DOD) for a CSHC holder triggers:

• DPS to “Off” the “SHC” BELI (as well as any other BELI) for the DOD
• the card system to remove the card eligibility.

Changes

The introduction of the new CSHC recording  facility in VIEW and the (possible) eligibility of CSHC holders to telephone allowance has necessitated the introduction of extra database records.  Unfortunately, technical issues with system environments preclude DPS from being able to update these new records upon a client's death.

The changes that will be introduced will update these new records upon a client's death.

New Processing

A new program will be introduced to run immediately following DPS each evening.  DPS will provide the same functionality as it currently does with the new program providing the required updates to the new records.

For each CSHC client that has a DOD recorded and is processed by DPS the following will occur:

• The CSHC eligibility recorded in VIEW (specifically in the CL_BEN_ELIG O* table) will be set to “Off” with “Effective Date” equal to the DOD and “Decision Date” equal to the date of processing.
• A check is made to ensure that the BELI has been turned off.
• If the deceased client has not been reassessed (with a corresponding new DPS assessment) then the file number is inserted into the TA reassessment trigger table (specifically CL_TO_RECORD_TSI).  This is because a DPS reassessment will reassess TA for the deceased and any partner but if this has not occurred the TA reassessment trigger must be set.

DPS Reports

A new section has been added to the daily DPS report which lists the file number, client suffix and unique identifier for any client who has had the CSHC record turned off and TA recalculated.

Points to note

There are several points to note regarding then new functionality:

• This functionality will ordinarily be fully automatic.
• If the case is not processed by DPS automatically then the CSHC record should be checked and set to “Off” in VIEW manually if required.  These cases will appear on the existing DPS report as requiring manual processing.