Transition Issues Paper - Preparation and Transfer of Files (Protocols and Advice)

This paper has been prepared following discussions on Transitional Arrangements for Claims

Management at the CMC 28-29 April 1998, in Melbourne.

It instructs and advises all State Office Claims Teams on procedures for the preparation and transfer

of files to the Claims Management Centres (CMC) in ACT and Victoria.

These instructions will be invoked according to the agreed timelines for states sending claims files to

each of the CMCs.

Preparation Phase (commencing from 1 May 1998)

1 — st Step:  Locate unactioned correspondence from in-trays, concertina files, bottom draws, etc and resolve – or – for correspondence that cannot be resolved prior to file transfers, send written acknowledgement and attach to file in a plastic sleeve on inside cover of file.  NFA corres. to be attached to file and folioed.

2 — nd Step:  Claims Services Managers to receive Excel Document of their State's Open Claims by A, B, C, D (priority) category by ultimate destination – by date of injury (Robert Pugsley to send - 5 May 1998).  Divide lists by claims manager, distribute, and explain priority system of managing all open claims (active and maintenance) with the aim of freeing claims staff resources for project work associated with moving files (eg finalising outstanding action, documentation of action to date, etc).

Freeing Claims Staff Resources

To reinforce this message, it is required that all claim files can be sorted and grouped into the A (Active), B, C, D (Maintenance) priority categories, and CMC destination, then colour stickered and further identified as requiring action, or not (again by colour sticker).  To take this process further, it is recommended that the claims teams be re-organised into Active and Maintenance Teams.

State Managers/Claims Services Managers can decide on the timing of the file colour stickering and team reorganisation relative to the timeline of when the files will move, however, the colour stickering must be completed by the time claim files move to the CMCs.

3 — rd Step: Claims Managers to locate their allocated claims files and to then FLOC according to the agreed categories (see box below) then physically arrange claims files into categories on their desk ready for colour identification (see colour category box below) and relocation. Files unable to be physically located should be highlighted on listing – then a search undertaken to locate.

FLOC Categories

Other Fields		3 Character FLOC Field		Comments Field
Current State Identified through the 001, 002 etc code on the FLOC screen	Category		Destination		[Action Required]
Suggest make File Location Type “O” (other)	UND AC MT,or PRP		A or B		“Red Dot”, or “Green Dot”
	Key: UND=Undetermined; AC=Active; MT = Maintenance and includes CategoriesB (Review);C (Low maint).; D(Review to Close); PRP=PrePremium		Key: A=ACT; B=VIC		Key: Red Dot = Yes Green Dot = No

(PrePremium Files are separately located and managed in “Maintenance” Team up to transfer)

Colour Categories

	Status
Destination	Active (A)		Maintenance (B, C, or D)
CMC-ACT	Gold		Pink
CMC-VIC	Orange		Black
	Action Required		Action Required
	Yes = red	No = green	Yes = red	No = green

4 — th step:  Discuss concept of and decide on Resourcing of Teams to reflect new CM priorities/resourcing model of:

1 CM per 80 “A” Active including new claims.

1 CM per 150 “B” Review open claims

1 CM per 200 “C” Low Maintenance open claims

1 CM per 400 “D” Review to Close open claims

1 CM per 350  “P” Pre-premium Claims

“Spare” staff are therefore released for Project work.  Reorganise claims staff into new teams structure.  New claims teams to collect relevant files and locate into claim team file range/bay/storage.

Note: ACT has organised teams into:  New & Undetermined; Active (ACT); Active (VIC); Maintenance (ACT) & (VIC); Benefits Processing; and Project  [see Paper “ACT Transitional Structure – Timelines”]

Management Phase

State Managers should emphasise and clearly communicate that New Claims and designated “Active” Claims are to receive full Claims Management and Customer support, as will claims where the Customer has requested a review (consistent with Comcare's “Charter of Partnership” obligations).

To free Claims Staff resources there should be a clear understanding that minimal or no Claims Manager initiated medical reviews, call for medical reports, investigations, etc. be commenced on non-active (maintenance) claims for the duration of the transition period.  There should also be no claims cessation or subsequent claim benefit denial decisions made for “grey area” claims that will clearly result in a claimant application for a reconsideration – (for the duration of the transition period only).

Claims Staff should initially target Category D claims with a view to validly close,  (but not cease) any category D file, and to put away and FLOC  to the closed/non-active file range/bay. This results in minimisation of the files to be transferred.

Benefit Processing

Aim for benefit processors in each office processing 90% or more of all medical, incap, travel etc claims received (less than 10% hand-off to claims managers).  In other words, pay all “grey area” claims and hand off to claims managers only claims that are very non-standard or well outside the bounds of reasonableness.   Note: It may be helpful if Claims Processors have “RROC” PRACSYS assess to streamline the paying of reasonable benefits to “closed” claims (these claims should then be immediately “re-closed”).  Aim to have a NIL backlog of benefits processing on hand.

Claims managers to set “generous” claim/sub-claim cut off dates and diaries.  For dir-pay claims set incap det review dates for next birthday after Sept 1998.

Documentation

Target clean-up and documentation to the prescribed Transfer Proforma (see below) on next claims to move as per each state's file movement schedule.

Transfer Phase

Advices:

Letter to Claimant:  PRACSYS/Word generated – NOD will produce text

Letter to Customer: PRACSYS/Word generated – NOD will produce text

Timing:-  1-2 days prior to transfer

Tracking:- All files being moved to be FLOC-ed  by:

FLOC Categories

Other Fields		3 Character FLOC Field		Comments Field
Current State Identified through the 001, 002 etc code on the FLOC screen	Category		Destination		First Line “Red Dot”, or “Green Dot” – “sent to (eg) VIC 6.7.98”
Suggest make File Location Type “O” (other)	UND AC MT,or PRP		A or B  (for AC or MT)		Second Line Series# (1-999)
	Key: UND=Undetermined; AC=Active; MT = Maintenance and includes CategoriesB (Review);C (Low maint).; D(Review to Close); PRP=PrePremium		Key: A=ACT; B=VIC		Key: Red Dot = Action Req Green Dot = No Action

Eg: FLOC Code “ACB” – FLOC Comments “Green Dot – sent to VIC 6.7.98”, “045” Currently in State 002 = a NSW Claim, Category Active, going to VIC, on 6.7.98  [Number # 045].  This file is then put into an archive box prior to transfer with like files.  The Box that this claim will be in will contain all ACB Green Dot files with (eg) #25-#45 files.  There will be a manifest of all claims in this box  ( + retained in the despatching office).  This manifest can be produced from PRACSYS claims by FLOC.  Mark outside of box.

Despatching/Receiving:

All category “AC” – claims will likely be sent by O/N secure courier (a claims manager-to-claims manager transfer).  Category MT (Maintenance) files can be sent by secure road freight and unboxed, checked against the manifest, and put in bays  (in receiving teams) by registry personnel.

Upon Receipt the receiving CMC Office (ACT or VIC) will update the State Office code field and mark the date of receipt/unpacking in the comments field.

Logistics/Materials:

Corporate Centre to advise on acquisition of archive boxes, freight arrangements, sufficient file ranges/compactus in receiving offices etc.
Complete “Transfer Proforma” for files to move as follows:

Transfer Proforma (do not include this proforma on the  file)
Claim Number:              /                      Doi     /     / Claim Indicator (circle)       COLD>>>>HOT
Claimant	W	X	Y	Z
Doctor	W	X	Y	Z
Provider	W	X	Y	Z
Employer	W	X	Y	Z
Outstanding Claim Action : Overpayment Action?: Investigation?:
For History Contact . . . . . . . .  Phone X . . . .
Comments:
Transfer Q/A – To be completed on boxing and despatching ❏PRACSYS Updated , ❏New FLOC # ❏Colour Sticker Updated ❏Q/A-officer                                                                     Signed:                                                                                                 Date:   /   /
Transfer Q/A – To be completed on un-boxing and receipt ❏PRACSYS - FLOC Updated, ❏Red Sticker File Allocated to Claims Manager ❏Q/A-Officer                                                                  Signed:                                                                                                Date:   /   /
Circle 'Action Required' and 'Destination' Red= Action; Green= No Action Gold=Active to ACT; Pink=Maint to ACT; Orange=Active to VIC; Black=Maint to VIC