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MSRS Registration and Scrutiny Guide

MED-MSRSR&SG01

Version: 3 (final)

7th March 2011

Medical Services

MSRS Registration and Scrutiny Guide 3 (final)

MED-MSRSR&SG01

Document control

Superseded documents

Version history

Version Date Comments

3 (final) 07 March 2011 MSRS Release 2.3

2 (final) 22 June 2010 Approved by MSCMT

1 (final) 27 February 2009 Approved by MSCMT

Changes since last version

Although following the issue of UTS 22/2010 WFHRA has been temporarily suspended for a period of 2 years references to WFHRA will remain within the guide.

Outstanding issues and omissions

Updates to Standards incorporated

22/10, 31/10, 05/11

Issue control

Author: xxxxx xxxxxxx

Owner and approver: The Operations Manager

Signature: Date:

Distribution: LiveLink

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Contents

1. 7 Introduction

1.1 7 Purpose of This Document

1.2 7 Applicability

1.3 7 Owning Process

1.4 7 Owner

1.5 7 References

2. 8 Receipt of Post

3. 9 Entering MSRS

3.1 9 Opening MSRS

3.2 9 The Home Page

3.3 10 Search for a Client

3.3.1 11 Search produces results

3.3.2 11 Search does not produce results

4. 12 Actions upon Receipt of the Questionnaire

4.1 12 Checking for an existing Case File

4.1.1 12 National Insurance Number Different

4.1.2 13 National Insurance Number Missing

4.2 13 Recording receipt of the Questionnaire

4.2.1 13 Recording receipt

4.3 14 Mandatory checks

4.3.1 15 Name

4.3.2 15 Claimant Address

4.3.3 15 Date of Birth

4.3.4 15 Contact Details

4.3.5 16 Availability constraints

4.3.6 17 Wheelchair User

4.3.7 17 Special Needs

4.3.8 17 PV Text

4.3.9 18 GP Details

4.3.10 18 Claimant has died


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4.4 19 Things not to check

4.4.1 19 Appointee Details

4.4.2 19 Signature

4.4.3 19 Defaced Questionnaires

4.5 19 Undelivered Questionnaires

4.6 19 Other paperwork included with the Questionnaire

4.6.1 19 Medical Evidence

4.6.2 20 Valuables

4.7 20 Change of Circumstances

4.8 20 Action following receipt

4.9 21 Duplicate Questionnaire received

4.10 21 Late Receipt of Questionnaires

5. 23 Creating a Case File

6. 24 Receipt of Supporting Case Files

6.1 25 IB/ESA Advice

6.2 25 IB/ESA Reconsiderations

6.3 26 TI Referral

6.4 26 S Referrals – sub-category S

6.5 26 S Referrals – sub-category ED

6.6 26 Q Referrals

6.7 26 PV Clients

6.8 26 Case File Not Received

6.8.1 27 T I Referrals

7. 28 ED Referrals

7.1 28 Basic process

7.2 28 Accepting a Referral as ED

7.2.1 29 ESA55 Case File

7.2.2 29 Decision Makers’ Decision

7.2.3 29 BF223

7.2.4 29 DNA1 v5

7.3 30 Updating MSRS

7.4 30 Workstack and Pre-Board Check selection


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7.5 31 Recording Receipt of the Case File

7.6 31 Feedback

7.7 32 Incorrect FME option selected

7.7.1 32 Sent to Workstack incorrectly

7.7.2 32 Sent to Pre-Board Check incorrectly

8. 33 Withdrawals

9. 34 Rejections

9.1 34 Rejection Procedures

9.2 34 S Referrals

10. 35 Case File returned from Practitioner

10.1 35 Referral Statuses and required action

10.1.1 35 Medical Audit

10.1.2 36 FME Dispatch

10.1.3 36 FME Receipt

10.1.4 36 FME Pending Exam

10.1.5 36 Off-Line DV Allocation

10.1.6 37 Customer Action

10.1.7 37 Workstack

10.1.8 37 Doctor Approval

10.1.9 37 Extract Case File and Extract Case File Pending exam

10.2 38 Wheelchair Users

10.3 38 Information Missing

10.3.1 39 Returning a section of the Questionnaire for completion

10.3.2 39 Completed sections of Questionnaire returned within the BF

10.3.3 39 Requested sections of Questionnaire not returned within the BF

10.3.4 40 Completed sections returned after the BF has expired

11. 41 FME

11.1 41 FME requests not returned by expiry of the BF

11.1.1 41 “Extract Case File Pending Exam” Referral Status

11.1.2 41 “Extract Case File” Referral Status

11.2 41 Checking for an existing Case File

11.3 42 Receipt of FME within the BF


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11.4 42 Receipt of Late FME

11.5 42 Recording Receipt of Unlisted FME

11.6 43 FME received on Questionnaire Referrals

11.6.1 43

Client Exempt, Accepted, Deferred, Treat as LCW or in Support Group

11.6.2 43 HCP unable to advise

12. 44 View Action Prompts

12.1 44 Change DV Address

12.2 44 Update Case File

12.2.1 45 Change to Surname

12.3 45 Relocate Case File

12.4 45 Progress Case File

13. 47 Change of Circumstances

13.1 47 Change of Diagnosis

14. 48 Back Office contacted by Clients

14.1 48 Request of Welsh, Braille or Large Print IB/ESA50s

14.2 48 Questions regarding Questionnaire completion

14.3 48 Data Protection Act related requests


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1. Introduction

1.1 Purpose of This Document

This document describes the operation of MSRS. Atos Healthcare staff should refer to this document when carrying out administration duties associated with Employment and Support Allowance (ESA).

1.2 Applicability

The document applies to all Atos Healthcare staff that work in Registration and Scrutiny teams at Medical Services Back Offices.

1.3 Owning Process

Service Operation.

1.4 Owner

The Operations Manager owns this document.

The owner is responsible for approval of this document and all related feedback should be addressed to them.

1.5 References

MSRS Terminal Illness Related Referrals Administration Guide MED-MSRSTIRRAG01

Management Checks Guide MED-MCG01

ESA Undelivered Mail Guide MED-ESAIBUM01

MSRS Resource Team Guide MED – MSRSRTG01

MEC Administrator’s Guide MED-MECAG01


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2. Receipt of Post

When post is received it should be sorted to ensure that the relevant item of post goes to the relevant team.

Any post that is destined for the Registration and Scrutiny team should be sorted by type (e.g. ESA50s/ESA50A, Case Files, ESA113s, other FME etc.) to enable more efficient processing. Receipt of Questionnaires should be recorded on MSRS as a priority.

Unless stated otherwise throughout this guide, all post received should be date stamped with the date of receipt.

With the exception of anything identified as valuable (see section 4.6.2), all post received should be hole-punched in the TOP LEFT HAND CORNER to facilitate its inclusion in a Case File.


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3. Entering MSRS

3.1 Opening MSRS

To open MSRS, double click on the MSRS icon on your desktop.

An Internet Explorer window will open and you will be taken to the MSRS Home Page with the Declaration showing.

3.2 The Home Page

On the home page is a declaration that the user must read and accept before accessing the system. This declaration must be accepted each time you enter the system – e.g. at the beginning of your working day, if you have closed the system and re-opened it or it is has been left inactive for a while.

To accept the statement click ‘Accept Declaration’.

You will be taken to the Search for Client page. The menu headings on the left side of the page will now be activated and show up as blue and underlined.

Throughout MSRS, any heading or text that is blue and underlined in this way is a


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hyperlink. Clicking on this link will take you directly to the part of MSRS indicated by the heading or text.

In addition, for the two Client and Case hyperlinks that appear at the top of a page and the hyperlinks on the left side of the screen, there will also be a keyboard shortcut. If you hover the mouse pointer over the hyperlink you will be shown what the shortcut is.

Shortcuts will only work where there is a hyperlink on the page that it can relate to.

To use the shortcut, press the keys indicated and then press enter.

3.3 Search for a Client

To begin using MSRS, a user must first of all search for a Claimant. This enables the user to see whether the Claimant already exists on the system.

NiNo Search

A NiNo search can be instigated from any screen within MSRS without the need to return to the Search for Client screen.

The NiNo search box can be found on the top left hand side of MSRS.

Client Details Search

To make a search using any other criteria as listed below, or the NiNo wasn’t found on the NiNo search, select the Search Client Details screen. The user types the Claimant details into the search boxes and clicks Search. Some boxes can be used alone as a single search and some must be used in combination with other information as a multiple search.

It is good practice to use the NINO as often as possible as this is a unique identifier and will only produce one result for each search.

The descriptions below indicate which fields can be used singly and which can be used as part of a multiple search.

NINO. The Claimant’s unique identifier, this can be part of a single or a multiple search, though a single search is recommended. The NINO must be entered into the field with the correct format of letters and numbers e.g. AB123456C, though it may be typed in using lower case letters.

Surname. Single or multiple search. Recommended as a multiple search with other fields completed to reduce the number of possible results. This can also be a partial search using the first part of the name (e.g. “SMI” instead of “SMITH”).

First Name. Multiple search, there must be at least one other field completed. As with surname, this can be a partial search.

Postcode. Single or multiple search. It is possible to search using the first


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half of the postcode, this then becomes a multiple search and there must be at least one other field completed.

Date of birth. Single or multiple search. Format must be DDMMYYYY, and can be typed with no spaces or with one of the following spacing characters – hyphen (-), full stop (.) or forward slash (/), whichever format is used all 8 numbers must be included.

3.3.1 Search produces results

When searching using anything other than NINO, a search will usually generate a list of possible matches.

Where a search generates a very long list, the system will display the following message, in red at the top of the page:

“Too many records found for the search parameters. Please refine your search criteria”

The number of records can be reduced by adding other information to refine the query.

Where the list does include the correct Claimant, the user can select the correct one by clicking the View button in the column labelled View Client.

3.3.2 Search does not produce results

If the search is unsuccessful the following message will be displayed, in red at the top of the page:

“No records found for the search parameters”.

You should now carry out a client trace. We recommend you try the following combinations of search items:

Surname, Forename and Date of Birth

Date of Birth and Postcode

Postcode alone

If you are still unable to locate the Claimant record, you should contact the referring Customer Office to discuss.

The required Customer Office can be inferred from the Claimant’s address.

If you are unable to identify which Customer Office to contact or you are unable to make contact with the appropriate Customer Office the item should be given to your manager who will escalate the issue with the regional ESA Lead.


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4. Actions upon Receipt of the Questionnaire

The return address for any ESA50/ESA50A issued through MSRS will be an Atos Healthcare Back Office.

All Questionnaires received at a Back Office should be dealt with in the same way regardless of whether they are in connection with a live or closed Referral. Therefore all of the following actions should be applied to all Questionnaires received.

4.1 Checking for an existing Case File

You must always check for the existence of a Case File prior to recording the receipt of a Questionnaire. This is because the act of recording receipt of a Questionnaire will automatically set the Supporting Case File field to YES, so thereafter you will be unable to determine from the system whether or not a Case File already exists.

To check for the existence of a Supporting Case File, access the View case screen and check the supporting Case File field on the latest Referral. If there is a live Referral and the Supporting Case File field says NO you should create a new Case File as directed in section 5.

If the Supporting Case File field says YES, a Case File already exists. You should locate the Case File and link the Questionnaire to it.

If you are unable to locate the Case File, having carried out a complete search of the Back Office and associated MECs, you should obtain authorisation from your Team Leader to create a new Case File and link the Questionnaire to it. Team Leaders should keep a record of all new case files created in this scenario and report this regularly to the Site Manager.

The checks listed in section 4.3 must be undertaken before recording receipt of the Questionnaire. Details of how to do this can be found in section 4.2.

4.1.1 National Insurance Number Different

If a Questionnaire is received and the NINO held on MSRS is different to that written on the Questionnaire, you should contact the referring customer office and ask them to confirm what the correct NINO is. The resulting actions required are different depending on the scale of the discrepancy. If the NINO requires changing on MSRS this is done using Update Client Details.

4.1.1.1 Single Character Errors

Where there is only a single character difference between NINOs e.g. a C is quoted on the Questionnaire but MSRS has an A, the referring Customer Office should be contacted by Telephone and the NINO queried.


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If the NINO on the Questionnaire is incorrect, change the NINO on the Questionnaire and initial the changes. Changes must be made in Black Ink.

If the NINO on MSRS is incorrect, the referring Customer Office must complete an MSRS Amendment Form and fax it to the MSC. Once MSRS has been updated the MSRS Amendment Form must be retained by the LSA for a period of 6 months.

If an ESA55 Case File exists, the NINO held on the ESA55 should be updated accordingly.

4.1.1.2 Multiple Character Errors or NINO Completely Different

If the NINO held on MSRS contains multiple characters that do not match those written on the Questionnaire, the following process must be applied:

Contact the referring Customer Office by Telephone and explain what has happened.

Advise them that you will be returning the Referral to them for them to investigate further.

Record receipt of the Questionnaire; create a Case File (if one does not already exist) and Withdraw the S Referral.

You should return the Case File and Questionnaire to the referring Customer Office using the cover sheet which can be found in Appendix C .

4.1.2 National Insurance Number Missing

If a Questionnaire is received that has no NINO stated on it, you should carry out the Client Trace actions as stated in section 3.3.2.

If having carried out the required action you successfully identify what the NINO is, you should write this on the Questionnaire in Pencil. You should initial all changes made to the Questionnaire.

4.2 Recording receipt of the Questionnaire

4.2.1 Recording receipt

Remember, you must have checked whether or not you need to create a Case File before recording receipt of the Questionnaire. See section 4.1 for further information.

If the referral is closed see section 4.10 for further information and next action.

Once the NiNO has been entered you will be on the View Client screen, select the Live Referral radio button and Go.

On the View Case screen check the back office.


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If the Back Office is incorrect

- Record Receipt of Questionnaire (see below for details on how to do this)

- Create a Case File where appropriate and place the Questionnaire in it.

- Write a brief memo explaining the Questionnaire was received at the incorrect Back Office and attach to Case File

- Send the Case File (where appropriate) to the correct Back Office location.

Back Office is Correct

Navigate to the View Case/ View Referral screen. If the Referral Status of the Questionnaire Referral is Questionnaire Reminder Issue or Questionnaire Receipt you should click on it. This will take you to the Record Questionnaire Receipt screen. If the referral is closed refer to section 4.9.

All information needed to record questionnaire receipt is contained on the Record Questionnaire Receipt screen.

Mandatory Checks listed in section 4.3 must be completed at this point.

Select Record Receipt to confirm and save actions

MSRS will then progress the workflow automatically as appropriate, as determined by the Status of any open Referral.

Having created a new Case File or linked the Questionnaire to an existing Case File (as directed in section 4.1) you should progress the item as directed by MSRS. See section 5 for information on creating Case Files.

4.3 Mandatory checks

The information contained on the Questionnaire should be double checked against those held on MSRS.

The following details should be checked:

Name

Address

Contact Details

Availability Constraints

Special Needs

PV Text

GP Details

DOB

Details of the checks and the required actions are detailed below.

If you identify something that requires updating on MSRS following the Mandatory

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Checks but you are not 100% sure of what the new data should be, e.g. due to illegibility, you should not make any changes to MSRS.

Any changes should be made to MSRS BEFORE recording receipt of the Questionnaire.

4.3.1 Name

This is contained on page 1 of the ESA50/ESA50A.

If a Questionnaire is received and the Name held on MSRS is different to that written on the Questionnaire, you should update MSRS.

4.3.2 Claimant Address


If a Questionnaire is received and the Claimant address held on it is different to that held on MSRS, you should update the address on MSRS to reflect the one held on the Questionnaire.

If the change of address results in a change of area e.g. Manchester to London, no change to customer office will be made. The Referral should be processed as normal, with the output being sent to the customer office that made the Referral.

4.3.3 Date of Birth


If a Questionnaire is received and the date of birth is different to that held on MSRS, contact the referring BDC and update MSRS as agreed.

To update MSRS, go to the Client Details screen and select Update Client Details, this will enable you to change the DOB. Click Update. You will not be able change the DOB in the Record Receipt of Questionnaire screen.

4.3.4 Contact Details

This is held on page 2 of the ESA50 and page 1 of the ESA50A.

If a Questionnaire is received that contains additional contact telephone numbers to those held on MSRS, you should update MSRS accordingly.

If the Any Other Number field is completed on the Questionnaire and the mobile number is blank, the additional number should be recorded on MSRS.

If both contact telephone number fields are already completed on MSRS and there are three numbers provided on the Questionnaire, you should ignore the number held in the Any Other number field on the Questionnaire.

Contact telephone numbers for people other than the Claimant must not be entered on to MSRS.


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If there are telephone numbers held on MSRS, but no numbers are written on the Questionnaire, you should not remove the numbers from MSRS.

4.3.5 Availability constraints

Any constraints on a Claimant’s availability should be shown on page 3 of the ESA50.

Regular Unavailability

If the Claimant is going to be unavailable to attend an examination on a regular basis e.g. every Tuesday, this should be recorded accordingly within the Availability Constraints field on MSRS.

If the Availability Constraint field on MSRS already shows a period of unavailability e.g. the Claimant is on holiday for two weeks, and there is an availability constraint end date set, this end date should be removed and the new end date entered where known.

Note you should only make a record of availability constraints that are still valid e.g. if the Claimant indicates that they are on holiday in March and it is now April, there is no need to update the Availability Constraints within MSRS.

Where an availability constraint is known to be limited, it is important that you enter the end date into the Availability Constraint End Date field. Failure to do so will lead to the system being unable to arrange a no contact appointment when the scheduling process starts.

Extended Unavailability

If, when checking the Questionnaire, you identify that the Claimant is unavailable for a period of more than 6 weeks (42 calendar days) for a non-medical reason (eg customer is abroad) from the date of the receipt of the Questionnaire at the Back Office. You should record receipt of the Questionnaire then withdraw the open S Referral from MSRS and return the Questionnaire to the referring Customer Office. For details on how to withdraw a Referral see Section 8. A case file should not be created.

If the client is unavailable for anything less than 6 weeks, the Availability Constraints field on MSRS should be updated and the Referral progressed accordingly.

Claimant returned to Work / No Longer Claiming ESA

If the Claimant indicates on their Questionnaire that they are working or no longer receive ESA you should withdraw the Referral. For details on how to withdraw a Referral see Section 8. A case file should not be created.

Claimant returning to Work

Where a Claimant states they are planning to return to work, contact the referring BDC to ask advice on whether to proceed. If advice is given to continue, the questionnaire should be recorded as received and progressed to Filework as normal. If you are asked to withdraw the referral see Section 8 for details on how to withdraw.


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4.3.6 Wheelchair User

If the Claimant indicates in the sections of their Questionnaire that they are a Wheelchair user, this information should be added to the availability constraints field within MSRS. No end date should be set.

4.3.7 Special Needs

This is contained on page 3 of the ESA50.

Interpreter

If MSRS indicates that the claimant has requested an interpreter but the received Questionnaire makes no mention of this, you should not make any changes to MSRS.

If the Questionnaire indicates that an interpreter is required and specifies a language but MSRS does not reflect this, you should update the Claimants details on MSRS accordingly. (NB: the requirement for an interpreter must not be recorded as an availability constraint; it should be updated on the Client Details Screen.) The referring customer office does not need to be informed of the change.

If the Claimant requests an interpreter within their Questionnaire but does not specify which language is required, no changes should be made to MSRS.

Same Gender Practitioner

If MSRS indicates that the Claimant has requested that they be examined by a practitioner with the same gender as themselves but the received Questionnaire makes no mention of this, you should not make any changes to MSRS.

If the Claimant requests that they be examined by a practitioner with the same gender as them on the Questionnaire, you should update the client details on MSRS accordingly by selecting the tick box. (NB: the requirement for a same gender practitioner must not be recorded as an availability constraint) The referring customer office does not need to be informed of the change.

Blind

If the Claimant indicates in the Questionnaire that they are Blind and would therefore require a Braille or Recorded version of their appointment letter, this should be added to the Availability Constraints field on MSRS and no end date set.

4.3.8 PV Text

PV information is keyed in by JCP at registration and is shown on the Record Questionnaire Receipt screen within MSRS.

If a Referral is received that is identified as being PV the PV Text field must explain why the client is identified as PV. If the explanation is insufficient e.g. the field is


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completed with “TBC”, “PV Paperwork Missing” etc, the referring BDC should be telephoned with a request to update the information on MSRS. If the BDC are unable to update MSRS with the correct information then rejection procedures should take place, see Section 9.

4.3.9 GP Details

ESA50

These details are found on Page 4 of the ESA50.

If there aren’t any GP details on the questionnaire but there are details on MSRS, do not remove them.

If the details on the Questionnaire are different to those on MSRS, then update MSRS accordingly.

If full GP details are not provided i.e. GP name, address including postcode and telephone number, then these details must be confirmed and entered into MSRS.

Where full details are not provided, an investigation should be completed using the NHS Choices website, or the Royal Mail Post code search website.

http://www.nhs.uk/servicedirectories/pages/servicesearch.aspx Select GP Search

http://postcode.royalmail.com/portal/rm/addressfinder?pageId=pol_login&catId=400145&_requestid=770821&cs=1

Where dummy GP details have been entered on MSRS (for example the BDC address has been used), and no GP details have been provided in the questionnaire, the dummy data should be removed from MSRS.

If you are still unable to find GP address details, contact the referring BDC and confirm the GP details they hold. If the BDC does not have GP details, leave the GP Details section on MSRS blank.

ESA50A

The ESA50A questionnaire does not contain a section for GP details. If the GP details section in MSRS contains dummy information, then the referring BDC must be telephoned. If they do not have any GP details, remove the dummy details from MSRS and progress.

4.3.10 Claimant has died

If a Questionnaire is received that indicates that the Claimant has died you should contact the referring Customer Office for advice on how to proceed. If the advice is to withdraw the referral, see Section 8 for details on how to do this.


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4.4 Things not to check

On receiving the Questionnaire it is essential that only checks are completed. For the avoidance of doubt, the following items should NOT be checked.

4.4.1 Appointee Details

An Appointee for a Claimant can only be changed on the authority of the Referring Customer Office and you should only therefore change Appointee Details on MSRS following a request from them.

You should not make any changes to the Appointee Details held on MSRS, even if you receive a Questionnaire that appears to have been completed by the Claimant’s Appointee but the details are different to those held on MSRS or MSRS does not hold any appointee details.

Similarly, if a Questionnaire is received that has been completed by someone other than the Claimant you must not update the Appointee Details fields on MSRS.

4.4.2 Signature

You should not check for a Signature upon receipt of a Questionnaire.

If a signature is missing, this will be noted by a Practitioner during Filework. If they require a signature in order to obtain FME, they will bring this to your attention. See section 10.4 for further information.

4.4.3 Defaced Questionnaires

Occasionally a Questionnaire may be received that has been defaced by the Claimant e.g. pages have been torn out or questions struck through.

Such Questionnaires should be treated in the same way as other Questionnaires i.e. receipt should be recorded on MSRS and progressed accordingly.

4.5 Undelivered Questionnaires

If a Questionnaire is returned indicating that it could not be delivered to the intended recipient e.g. it is returned marked as “Not at this address”, refer to the ESA Undelivered Mail Guide.

4.6 Other paperwork included with the Questionnaire

On occasion, a Claimant will send other pieces of paperwork along with their Questionnaire. Such pieces of paperwork may include a letter from a consultant, a Medical Certificate, Birth Certificate, Passport etc. Should anything be received with the Questionnaire, please follow one of the processes outlined below.

4.6.1 Medical Evidence

Any letter, form or report completed by a Medical Professional is classed as Medical


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Evidence.

Any Medical Evidence received with the Questionnaire should not be recorded on MSRS as Unlisted FME, but should be inserted in to the Case File along with the Questionnaire.

If the item of Medical Evidence is a MED3, a photocopy of the MED3 should be inserted in to the Case File and the original should be returned to the referring customer office.

4.6.2 Valuables

Claimants have often sent Valuable items to the JCP with their completed Questionnaires even though they are not requested or needed.

A list of items regarded to be valuable is available in Appendix A upon receipt of any such item the valuables ledger, attached to 14.3Appendix A , must also be completed as a record. There should only be one ledger in existence per Back Office.

Such items should be immediately returned to the Claimant by Recorded Delivery. A covering letter must also be sent with the items to the Claimant. A copy of the letter to be used is included within Appendix A you should list the items of valuables being returned to the Claimant within this letter.

Please note, valuables should not be date stamped or hole punched.

4.7 Change of Circumstances

If any changes are made at the point a questionnaire is received, MSRS will send an automatic notification of Change of Circumstance to the Customer and a CC1 is not required.

4.8 Action following receipt

Once you have recorded receipt of the Questionnaire it will be apparent from the View Case screen in MSRS how it should be progressed – e.g. pass to practitioner for filework or OCP filework, or return to customer. If you are returning the Questionnaire to the customer, you should already have identified whether a Case File is needed or not.

Note: HCPs may not be trained in all types of filework activities, care should be taken to ensure that any allocated filework sessions are appropriate to the HCP Skill set.

Pre-WCA Review Flag

Check the Pre-WCA Review flag on the View Referral screen to ensure the referrals are passed to an appropriately trained HCP.

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Pre-WCA Review Flag Ticked = Old Rules

Pre WCA Review Flag not Ticked = New Rules

Where the Case shows outstanding OCP activity this means it has progressed beyond the initial filework stage and as a result should be passed to a member of the Resource Team for action.

4.9 Duplicate Questionnaire received

If you receive a duplicate Questionnaire, it is important to realise that the Questionnaire now received may contain different or more up-to-date information than the one previously received. The normal checks should be undertaken and where appropriate, receipt of the Questionnaire recorded. If receipt of a questionnaire has already been recorded, the duplicate should be recorded as unlisted FME. Depending on the Status of any open Referral on the case, MSRS will indicate that this has triggered a need for filework action, OCP filework action or the return of the Questionnaire to the customer as described in section 4.8.

4.10 Late Receipt of Questionnaires

Upon the expiry of the 43 Calendar Day BF, MSRS will do one of two things:

If the Mental Health flag is set to YES, MSRS will automatically close the Q Referral and open an Electronic S Referral which will progress to Pre-Board Check

If the Mental Health flag is set to NO, MSRS will automatically close the Q Referral, but it will not create an S Referral.

If it is a LCWRA referral, MSRS will automatically close the Q Referral and open an electronic S Referral which will progress to LCWRA Filework

On late receipt of a Questionnaire the next action depends on the mental health flag Status.

If an S Referral has been created, you should check for the existence of a Case File. If one does not exist, you should create one. Having done this you should record receipt of the Questionnaire against the closed Q Referral and pass the Case File and Questionnaire to a HCP for filework.

If there is no open referral, you should write “Received after BF Expired” in the TOP RIGHT HAND CORNER of the Questionnaire and ensure that the Questionnaire has been date stamped with the date it was received. You should record receipt of the Questionnaire against the closed Q Referral then return it to the referring Customer Office. A Case File is not required in this instance.

In both of the above scenarios, there may or may not be a Supporting Case File. If there is a Supporting Case File, which has not yet been returned to the referring Customer Office e.g. because the Questionnaire arrived the day after the BF expired, the Referral Status on MSRS will be Extract Case File. Having retrieved the Case File from the BF storage area and recorded receipt of the Questionnaire


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on MSRS it is vital that you clear the Extract Case File Referral Status. You should also ensure that the Questionnaire has been date stamped with the date of receipt.

4.10.1 Questionnaire was received in back office but not recorded before the BF expired

All questionnaires are required to be recorded as received on MSRS on the date they arrived in the MSC. If for any reason it is not possible to record receipt of all questionnaires on the date of receipt, then this must be escalated to the National Performance Manager, by no later than close of business that day.

If this situation should arise, inform your TL if they are not already aware and provide an explanation as to why the questionnaire was not recorded. This will then be escalated via the SM to the National Performance Manager.


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5. Creating a Case File

All Case Files will be an orange ESA55.

The front cover of the ESA55 is reversible. Atos Healthcare staff should always create Case Files using the side labelled ‘Return of Supporting clerical documents’, as should the customer when creating a Case File associated with an MSRS Referral. Note that the side labelled ‘Clerical Referral to Medical Services’ will only be used when the customer is making a non-MSRS Referral.

The following fields should be completed:

Benefit Type

This is a tick box.

If the Referral is ESA, place a tick in the ESA box.

If the Referral is IB Re-Assessment, place a tick in the IB Re-Migration box

Special Indicator/PV Marking

If the claimant is identified as being PV on MSRS, stamp this box using the Chequered stamp and a Black ink pad.

Customer Details

The following details must be completed including, where applicable, on the spine of the Case File:

National Insurance Number

Surname

Title

Other Names

Return Documents to

Enter the Name and Office ID of the referring customer office.

Referral Progress

Enter the referral status and date.

Notes

Any Special Needs should be written in this section.

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6. Receipt of Supporting Case Files

Some MSRS Referrals will be made by the customer that have an associated Case File at the point of Referral. Such Referrals include:

Advice

o The Case File may not be an ESA55, it will most likely be some kind of supporting Medical evidence

Q (in exceptional circumstances only)

S (including ED Referrals made where the Claimant failed to attend their assessment)

With the exception of Q Referrals, the Atos Healthcare process and therefore the associated KPI does not start until the receipt of the associated Case File has been recorded.

Upon receipt of a Case File the following process should be followed, with the exception of S ED Referrals (please see section 7):

Carry out a search for the Claimant and view their record as described in section 3.3.

Ensure that the information held on the Case File matches that recorded on MSRS. If anything does not agree you should contact the Customer Office to ascertain what the correct information is and update MSRS or the Case File accordingly.

Select the appropriate case for that Referral using the radio buttons

Select ‘View Case’ from the ‘Case Actions’ drop-down menu and click ‘GO’.

You will now be on the ‘View Case’ screen for that particular case.

The Referral that corresponds to the received Case File will have a Referral Status of ‘Case File Receipt’. The exception being Q Referrals which will have a Referral Status of ‘Questionnaire Receipt’, in these circumstances the Case File should be placed in to the BF to await receipt of the Questionnaire or expiry of the Questionnaire BF. Additional information can be found in section 6.6.

The ‘Case File Receipt’ Referral Status is a hyperlink; click it to take you to the ‘Confirm Receipt of Case File’ screen.

Once on this screen click ‘Confirm’ to inform MSRS that you have received the Case File.

Once you have recorded receipt you should action the Referral as directed by MSRS, described below.


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6.1 IB/ESA Advice

The customer will register Advice referrals and indicate if a supporting case file (SCF) is available. Advice referral sub-categories are CN and CZ.

Supporting Case File Received Enter NiNo Check details on SCF against those on MSRS – See Section 4.3 Pass to CSD Practitioner On return of SCF from CSD Practitioner, check workflow status and progress

accordingly. See Section 10.2 for further details.

Advice Referrals without Supporting Case File – Team Leader Action Select the View Outstanding Filework Tasks screen Select your back office Tick the Advice box Select Get Filework Tasks Inform CSD Practitioner if advice referrals are listed

Please note that the View Outstanding Filework Tasks screen should be regularly checked throughout the day.

6.2 IB/ESA Reconsiderations

Reconsiderations will be registered on MSRS as Advice Referrals using the CZ Sub-Code. They will be recorded as having a Supporting Case File. The Case File will include an ESA60A.

Upon receipt of such Referrals, they should be treated as normal Advice Referrals.

If the reconsidered output requires re-examination, an S Referral should be registered by the District Data Manager/Administrator on the existing case that holds the reconsideration referral, as described in the Business Continuity Procedures document.

Having registered the Referral, the ESA55 should be passed to an HCP trained in file work. The HCP should give an output of Call to Exam. The Referral Status should be left at Workstack and the Referral should be passed to the Resource Manager immediately.

The Resource Manager should contact the Claimant, explain the situation and inform them that they will be required to attend the MEC again for re-examination. Once the Claimant has agreed to attend, the Resource Manager should manually release the Referral from the Workstack and schedule the appointment within Siebel. Once at the MEC, the examination can proceed as normal.


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6.3 TI Referral

Please see dedicated TI Referral Guidance for details – MSRS Terminal Illness Related Referrals Administration Guide MED-MSRSTIRRAG01.

6.4 S Referrals – sub-category S

The Case File should be passed to a practitioner for file work.

6.5 S Referrals – sub-category ED

Please see section 7 for full instructions on administering ED Referrals.

6.6 Q Referrals

If, when entering MSRS to record receipt of a Case File you notice that the Referral Status says Questionnaire Receipt and not Case File Receipt (i.e. there is an open Q Referral) this indicates the Case File has been received in support of the open Q Referral. You should check the Supporting Case File field on the View Case screen and take the action as described below:

Supporting Case File = YES

If the Supporting Case File field is set to YES, the Case File should be placed in the BF to await the receipt of the Questionnaire.

Supporting Case File = No

If the Supporting Case File field is set to NO, you must record receipt of the case file as Unlisted FME on MSRS. This will set the Supporting Case File field to YES. The Case File should then be placed in the BF to await receipt of the Questionnaire.

6.7 PV Clients

If a Case File is received for a Claimant that is identified as being PV you should read the PV Text field on the View Client screen. If complete PV details are not included e.g. the field is completed with “TBC”, “PV Paperwork Missing” etc, the referring BDC should be telephoned with a request to update the information on MSRS. If the BDC are unable to update MSRS with the correct information then rejection procedures should take place, see Section 9.

6.8 Case File Not Received

Every Monday the MI Team will run a report to identify all Referrals where we haven't recorded receipt of the SCF after more than 10 working days since the date of registration on MSRS. This file will be posted in the public directory in the folder 'Referrals registered not received'.

Each Monday the first action will be for the MSC to check for no backlogs of unrecorded Case Files. If you have any please ensure all are on the system


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before taking the next action.

For each Referral on the list access MSRS and record receipt of the SCF and then immediately reject the Referral, using category 'Other' and inserting in the free text box 'No SCF Rec'd'.

This action must be taken before the next weekly report is run.

6.8.1 T I Referrals

There may be instances whereby a TI Referral appears on the weekly Monday report run by the MI Team. If this is the case then it must be actioned urgently and as the system will not allow the Referral to be rejected it must be withdrawn. However, before the Referral is withdrawn we should always contact the JCP office by telephone to ascertain the whereabouts of the DS1500. If they confirm that there is no DS1500 we should withdraw the Referral and they should immediately re-register the TI Referral but making sure that they indicate that there is no SCF on MSRS.

If they confirm that there is a DS1500 we should ask them to fax it over to us immediately so that we can progress the Referral without delay.


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7. ED Referrals

This section does not relate to WFHRA ED Referrals. WFHRA ED Referrals do not have a Supporting Case File and are progressed directly to Workstack following registration.

7.1 Basic process

The flow chart below outlines the basic S ED Administration process.

ESA55 Received

Confirmed ED?

Y

Reject

Update MSRS

Y

Filework Action

Required?

N

N

Scrutiny/Pre-Board Check

Workstack

7.2 Accepting a Referral as ED

Before you can process an ED Referral, you must first confirm that the Referral is an ED Referral.

In order for a Referral to be considered an ED, the items described in the following sub-sections must be present and completed correctly.

You may be required to invoke rejection procedures, if so full details can be found in section 9.


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7.2.1 ESA55 Case File

All ED Referrals will have a Supporting Case File and so, upon receipt of the ED Case File, the Referral Status on MSRS will be “Case File Receipt”.

Any ED Referrals (except WFHRA Referrals) where a Case File is not received will be rejected as part of the normal weekly check (see section 6.8).

7.2.2 Decision Makers’ Decision

The Decision Makers’ Decision (DM Decision) will usually be submitted on form LT54. Usually, a complete description of the decision is given; however, sometimes they only say that good cause has been accepted.

In order for you to accept the DMs Decision, it must contain the words Good Cause.

If the DM Decision is not present or the words Good Cause are not included, rejection procedures should be invoked.

7.2.3 BF223

There are 3 kinds of BF223:

BF223(ESA) – used for ESA LCW appointments only

BF223(WFHRA) – used for ESA WFHRA appointments only

BF223(DV) – used for Domiciliary Visits

The correct kind of BF223 should be used. If an ED Referral has been received with an incorrect BF223 you should raise this with your Team Leader.

If a BF223 is not present, there should be evidence of a discussion with the Claimant included relating to their reason for non attendance e.g. evidence of a telephone conversation between the DM and the Claimant.

If the BF223 is not present and there is no explanation as to why it is missing contained within the DM Decision, rejection procedures should be invoked. However, if the previous referral was a LCWRA there will not be a BF223

7.2.4 DNA1 v5

The DNA1 form is used by the Referring Customer Office to give extra explanation where the reason for non-attendance was due to an admin error either by themselves, Medical Services, or Teleprogramming procedures were not followed correctly.

The correct version of the form must be used. Previous versions will have entries for all reasons. Version 5 of the form will only include entries for one of the three reasons below:


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Admin Error Medical Services

Admin Error Department

Teleprogramming Procedures Not Followed Correctly

The reason for non-attendance is captured on MSRS. If the reason is one of the above three and there is no DNA1 v5 form included, or the wrong version of the form is used, rejection procedures should be invoked.

7.3 Updating MSRS

Having confirmed that the Referral is a genuine ED Referral, you must now ensure that MSRS is completely up to date. This step is especially crucial if the reason for non-attendance is Admin Error Medical Services.

You should carry out the same checks as you would were this a brand new Questionnaire, as described in section 4.

If the BF223 indicates that the reason for non-attendance is because they did not receive a telephone call or did not receive their letter, you should take extra care when checking the Address and Contact Details and ensure that any changes described in the BF223, or anywhere else in the ESA55 if the BF223 is not present, have been replicated in MSRS.

If any details require updating, follow the process described in section 4.3.

7.4 Workstack and Filework selection

The administrator is required to check the age of the Questionnaire and for the presence of Medical Evidence. This check will determine whether the Referral progresses immediately on to Examination or if it needs to be seen by an HCP for filework action.

If any of the items listed below are present, the Referral must progress to an HCP for Filework action:

A Questionnaire is present that is dated as being received more than 12 months ago

o If the Questionnaire doesn’t have a date of receipt on it, you should check the date that it was signed, if it was signed more than 12 months ago the referral should be sent for Filework

o If the Questionnaire isn’t signed, you should check the date of receipt on MSRS

A 113 is present

A GP/HCP letter, GP Notes or letter from a professional organisation or any other advocate (e.g. Citizens Advice) is present


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Reason for non-attendance (stated in BF223, DM Decision or any other documentation) is medically related e.g. “I was too ill to attend”.

BF223 includes any medical information e.g. medically related appointments, change to medication etc.

If you are at all in doubt as to whether the ED Referral contains medical evidence, you should err on the side of caution and progress the Referral to Pre Board Check.

Please note, if the DM Decision states “Good Cause Accepted – Customer Issue, Mental Health”, these referrals should be progressed to Workstack, unless new medical evidence as described above is present.

7.5 Recording Receipt of the Case File

Receipt of the ESA55 Case File is done as follows:

On the View Case or View Referral screen, the Referral Status will be Case File Receipt, you should click this Referral Status

You will be taken to the Confirm Receipt of Referral screen.

This is the same screen that you normally see for other Referrals, but for ED Referrals, the Fresh Medical Evidence drop-down menu is visible

o If you wish to send the Referral for Pre-Board Check you should select YES from the menu

o If you wish to send the Referral to the Workstack, you should select No

o Please note all LCWRA Referrals will progress to filework regardless of the option selected.

Click Confirm

7.6 Feedback

If the DM Decision requests any of the following, this should be fed back to the Site Manager to be raised at the next LIM:

A request to send for FME

A request for a DV

A request for a specific MEC to be used (unless this was requested by the Claimant, but no BF223 is present)

A request for a specific appointment time (unless this was requested by the Claimant, but no BF223 is present)


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Please note the requests listed do not constitute reasons for rejection, therefore the Referral should be progressed unless there is a separate, legitimate reason for rejection, as per standard rejection procedures.

If the issue is with a member of JCP staff (e.g. the Decision Maker), the issue should be raised at your monthly LIM, unless you feel the issue is of such importance that it needs to be raised immediately.

In order to assist with the improving the chances of the Claimant attending the next examination, any issues identified in the BF223 for failing to attend the previous examination may need to be fed into the re-scheduling process e.g. if the Claimant states that public transport can’t get them to the MSEC before a certain time then the availability constraints field will need to be updated accordingly.

Any ‘erroneous’ Decision Maker good cause decisions and loop counts of 3 or more should be brought to the attention of the Site Manager, in order for them to raise at the LIM.

7.7 Incorrect FME option selected

7.7.1 Sent to Workstack incorrectly

If the Referral was incorrectly sent to the Workstack, receipt of Unlisted FME should be recorded, forcing the Referral to progress to an OCP filework status . The ESA55 should be passed to an HCP.

7.7.2 Sent to Filework incorrectly

If the Referral was incorrectly sent to Filework, you should pass the ESA55 to an HCP and request that they record an outcome of Call to Exam, unless the HCP feels that another outcome would be appropriate.


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8. Withdrawals

If you have to withdraw a referral for any of the following reasons, the withdrawal can be carried out without notifying the referring customer office:

Claimant unavailable for more than 4 weeks for non-medical reasons, e.g. on holiday

Claimant has returned to work

Claimant has gone abroad

If you need to withdraw a referral for any other reason, you must contact the referring customer office for approval first.

To withdraw a Referral, navigate to the View Referral or View Case screen and select ‘Withdraw Referral’ from the ‘Referral Actions’ drop-down menu, then click ‘Go’. This will take you to the Withdraw Referral screen. Please note, when withdrawing a referral from the View Case screen you must first select the referral you wish to withdraw before carrying out the actions below.

Select a Withdrawal Reason from the drop down menu:

o Client dead

o Client returned to work

o Client gone abroad

o Other

this withdrawal reason should be used if the claimant is unavailable for more than 6 weeks and any other withdrawal reason that has been agreed with the referring customer office

Optional text can be entered into the Note box. This section should be completed wherever possible, including a record of any discussion with the referring customer office

Please Note: When the Withdrawal Reason is ‘Other’, text must be entered into the Note box.

Click ‘Withdraw Referral’. This will withdraw the Referral and return you to the previous screen.

If you are in possession of the supporting case file the referral must be removed from the Extract Case File list found in the View Action Prompts section. For details on how to do this refer to Section 12.4.


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9. Rejections

9.1 Rejection Procedures

Wherever possible you should contact the referring Customer Office to ascertain what the missing piece of data is and update the Case File or Form as necessary.

Rejecting the Referral should only be done as a last resort.

9.2 S Referrals

If it is deemed necessary to reject the Referral within MSRS, the following process should be followed (note only S Referrals can be rejected within MSRS):

Navigate to the View Case screen for the Referral in question and select the Referral that needs rejecting using the appropriate Radio Button.

Select Reject Referral from the Referral Actions drop-down menu, then click Go

You will now be on the Reject Referral screen.

Select the appropriate Rejection Code from the drop-down menu

Enter notes explaining the reason for rejection in the text box

Click ‘Reject Referral’. You will now be returned to the View Case screen.

Having rejected the Referral you should return any paperwork received or Case Files to the referring Customer Office. A clerical rejection form is not required when rejecting a Referral within MSRS.


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10. Case File returned from Practitioner

Find a place for Incorrect S Referrals UTS

Once the practitioner has carried out their action, Referrals with no Case File will progress automatically and no Administrative intervention is necessary.

Referrals that have an associated Case File will be returned to the Administration section to ascertain what is to be done with the Case File.

Where the Referral has a Case File, Administration should check the new Referral Status on MSRS. This is done as follows:

Carry out a client search using the NINO as stated on the Case File and view the client record

Using the radio buttons, select the appropriate case. Select ‘View Case’ from the Case Actions drop down menu and click ‘Go’

Once on the View Case screen you will be able to see the current Referral Status of the Referral in question (it will be indicated as being a Live Referral).

The possible Referral Statuses are described below. Carry out the action required as described.

10.1 LCWRA Assessments

Team Leader Action

The filework HCP will separate any referrals where a LCWRA only assessment is required. You must place a note on the ESA55, marked LCWRA.

10.2 Referral Statuses and required action

10.2.1 Medical Audit

This Referral Status indicates that MSRS has selected the most recent Medical Output to undergo Quality Audit.

“Audit” and today’s date should be recorded in the Referral Progress section of the Case File. The Case File should be passed to the Administrator that is responsible for Audit.

Please note that audit Referral Statuses now include the Audit Type e.g. “Medical Audit – Targeted.


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10.2.2 FME Dispatch

Referrals that have a Referral Status of FME Dispatch need to be returned to the Practitioner.

This Referral Status indicates that the Practitioner has identified within LiMA that they require FME in order to make an informed decision but they have not issued the FME. Items of FME are issued by the Practitioners themselves through MSRS. Administrators do not have the required access level in MSRS to issue FME requests.

You should return the Case File to a HCP for them to issue the FME request.

The exception to this is where the HCP informs you that they require the client to provide information that is missing from a Questionnaire – see section 10.4.

Occasionally referrals without case files will be at FME Dispatch. Scrutiny TL will need to check View Outstanding Filework Tasks for these instances. If there are referrals at FME Dispatch, the TL must inform a filework HCP and request that they clear the FME Dispatch. This check must be done on a regular basis.

10.2.3 FME Receipt

This Referral Status indicates that the Practitioner has issued a request for FME.

“FME” and today’s date should be written in the Referral Progress field of the ESA55 and then put in the BF cabinets.

10.2.4 FME Pending Exam

This Referral Status indicates that the Practitioner has issued a request for FME but if the FME is not returned by the BF date, the Referral should progress straight to Workstack.

“FME Exam” and today’s date should be written in the Referral Progress field of the ESA55 and then put in the BF cabinets.

If the FME is received within the BF period, the standard FME process will be followed. If the FME is not received, when the BF expires, the workflow will progress to Extract Case File (where a Case File is present) or to Workstack or Audit where there is no Case File. Once Extract Case File has been confirmed, the Referral Status will progress to Workstack or Audit as appropriate.

10.2.5 Off-Line DV Allocation

This Referral Status indicates the practitioner has decided the Claimant requires an Examination and they qualify for a Domiciliary Visit.

“DV” and today’s date should be written in the Referral Progress field of the ESA55 and then it should be passed to the Administrator that is responsible for arranging


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DV Appointments.

10.2.6 Customer Action

This Referral Status indicates the Referral has been closed and control returned to the referring Customer Office. No further Atos Healthcare action is required.

“BDC” and today’s date should be written in the Referral Progress field of the ESA55 and returned to the referring Customer Office.

Not Support Group

Note for LCWRA referrals HCP’s may give the outcome of ‘Not Support Group’ in this instance the case should be returned to the referring Customer Office as described above.

10.2.7 Workstack

This Referral Status indicates the Claimant requires an Examination. The Practitioner has decided the Claimant can attend a MEC.

The Case File should be sent to the Claimant’s default MEC. The name of the Default MEC can be viewed on the View Client screen.

Where there is an associated Case File, the name of the MEC required should be written on the Case File in the ‘Referral Progress’ box, using a new line and noting the date.

The Practitioner will have identified within LiMA whether the Claimant can be examined by a Doctor or Nurse. MSRS will be updated automatically.

10.2.8 Doctor Approval

This Referral Status indicates the most recent Medical Output requires the approval of a Registered Medical Practitioner before any further action can be taken.

An example of when this might occur is when a Registered Nurse that has not yet reached Stage 7 approval records an outcome of Accept or Exempt.

The Case File should be passed to a suitably approved Registered Medical Practitioner for approval.

10.2.9 Extract Case File and Extract Case File Pending exam

This Referral Status indicates that FME BF has timed out, a questionnaire with a SCF has timed out or the referral has been withdrawn. Since you have the case file, you should click the referral status hyperlink to confirm that the case file has been extracted. The Referral Status will then update, and the case file should be sent on to the appropriate new location, e.g. back to the Referring Customer Office if the new referral status is Customer Action.


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Note: if you notice a change in First Name, Surname, PV Status or Customer Office you must check the View Action Prompt List.

In order to do this;

- Select View Action Prompts

- Select your Owning Office

- Select Update Case File

- If the change appears in the list, make the change to the ESA55 and clear the prompt from the list.

If the Surname has been changed please see Section 12.2.1

Progress the case file as described above.

10.3 Wheelchair Users

When reading the detail within Questionnaires and other FME, practitioners may identify that a Claimant is a wheelchair user. In these circumstances they are instructed to attach a note to the front of the Case File.

If you receive a Case File back from a practitioner that has such a note attached to it you should check to see if this is already reflected in the Availability Constraints field on MSRS. If it is not, you should update the availability constraints field accordingly.

10.4 Incomplete Diagnosis Where a nonsensical diagnosis has been entered onto MSRS and the client has not returned the questionnaire or the DWP have not sent an ESA55 which contains the correct diagnosed cause of incapacity, the HCP will pass the referral back stating that the diagnosed cause of incapacity is incomplete. In these instances you should check the MH flag on the View Case Details screen on MSRS. If the HCP informs you there is no diagnosis due to there being no previous Q referral these cases should be rejected selecting the reason ‘Other’ and entering in the free text box “Incorrect referral type”.

10.4.1 Mental Health Flag is set to No

In this instance the referral should be rejected selecting the reason ‘Other’ and entering in the free text box “Incap missing, please set MH flag if appropriate and provide a SCF with correct diag”.

10.4.2 Mental Health Flag is set to Yes

You should contact the referring DO to find out why the Mental Health flag was set and obtain the correct diagnosis. If JCP can provide valid details these must be recorded on form FRR4 (accessible from LiveLink). You will complete Part A, with the Claimant’s details and Part C with the above information. The FRR4 will then be


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enclosed in the case file (creating a new case file where necessary). You should then record unlisted FME. If details cannot be obtained from JCP the referral should be rejected selecting the reason ‘Other’ and entering in the free text box ‘Full incapacity required’

10.5 Information Missing Occasionally, a Questionnaire will be returned that is incomplete e.g. Declaration page not signed. If this is identified by a practitioner during Filework they will indicate within LiMA that they wish to adjourn for FME. However, instead of issuing an FME request within MSRS, they will omit this task, leaving the Referral Status at FME Dispatch. They will then inform a member of the Registration and Scrutiny team that they require the Claimant to complete the appropriate sections in order to proceed.

10.5.1 Returning a section of the Questionnaire for completion

If, as stated above, a practitioner asks you to return a section of the Questionnaire to the Claimant for them to complete, you should carry out the following procedure:

Photocopy the sections of the Questionnaire that need completing.

Mark the required fields with a red X and return them to the Claimant at the address held on MSRS. You should also send an IB/ESA52 covering letter indicating what action the Claimant is required to carry out. A Business Reply Envelope should also be included.

You should place the Case File into a clerical BF for 10 calendar days.

10.5.2 Completed sections of Questionnaire returned within the BF

If the completed sections of the Questionnaire are returned within the 10 Calendar Day BF you should carry out the following action:

Extract the Case File from the BF and link the completed sections to it.

Return the Case File to the practitioner for their continued action advising them that the Claimant has completed the required sections of the Questionnaire. Ask them to abandon the FME Dispatch in order to complete the Filework action as a priority.

10.5.3 Requested sections of Questionnaire not returned within the BF

If the required sections of the Questionnaire are not returned within the 10 calendar day BF you should carry out the following action:

Extract the Case File from the BF

Return the Case File to the Practitioner for their continued action advising them that the required sections of the Questionnaire have not been returned and that they will need to abandon the FME Dispatch in order to record a new Filework outcome.


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10.5.4 Completed sections returned after the BF has expired

Case File still in the possession of Medical Services

If the requested sections of the Questionnaire are returned after the BF has expired, but the Case File is still in the possession of Medical Services you should link them to the Case File e.g. if it is at the MEC you should send the completed pages to the MEC asking the MCA to link them to the Case File.

Case File returned to the referring Customer Office

If the requested sections of the Questionnaire are returned after the BF has expired, but the Case File has been returned to the referring Customer Office you should forward the sections of the Questionnaire to that office.

Receipt of the completed sections of the Questionnaire should not be recorded on MSRS.


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11. FME

Upon receipt of FME you should always record its receipt on MSRS even if the Referral has been closed. On an open referral, having done this (as described below) you should check what the new Referral Status is. If an OCP activity has been spawned (e.g. OCP Pre-Board Check) you should pass the item of FME to a member of the Resource Team for progression.

If the Referral is currently undergoing Audit, you should pass the item of FME to the Administrator responsible for Audit.

If the Referral is still at the initial Pre-Board Check stage progress, locate the case file and place the FME inside.

Note OCP activities will only be spawned once the Referral has progressed beyond the initial Filework stage.

11.1 FME requests not returned by expiry of the BF

Where an item of FME is not returned by the expiry of the 15 calendar day BF MSRS will automatically abandon the request and progress the workflow.

11.1.1 “Extract Case File Pending Exam” Referral Status

This Referral Status will appear in circumstances where an HCP has indicated that if FME is not returned, the Referral should proceed directly to the Workstack. When you clear this Referral Status, instead of passing it back to an HCP for Filework, you should place the Case File in the Workstack storage area for the appropriate MEC or pass it to the Audit Administrator depending on the new Referral Status.

11.1.2 “Extract Case File” Referral Status

This Referral Status will appear in circumstances where an HCP has indicated that if FME is not returned, the Referral should proceed back to file work. When you clear this Referral Status pass the case file to an HCP for Filework.

11.2 Checking for an existing Case File

You must always check for the existence of a Case File prior to recording the receipt of FME. This is because the act of recording receipt of FME will automatically set the Supporting Case File field to YES, so thereafter you will be unable to determine from the system whether or not a Case File already exists.

To check for the existence of a Supporting Case File, access the View Referral screen for the current open Referral. If the Supporting Case File field says NO you should create a new Case File as directed in section 5. If the Supporting Case File field says YES, a Case File already exists another case file must not be created.


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11.3 Receipt of FME within the BF

Where a practitioner has requested FME in order to reach a decision, the Referral Status of the Referral will be ‘FME Receipt’ or ‘FME Receipt Pending Exam’.

Receipt of FME is recorded on MSRS as follows:

Carry out a Client search as described in section 3.3 and view the Client record.

Select the appropriate case for the Referral using the Radio Buttons

Select ‘View Case’ from the ‘Case Actions’ drop down menu and click ‘GO’.

Once on the View Case screen, you will be able to see all of the Referrals associated with that Case. One of the Referrals will have a Referral Status of ‘FME Receipt’. Click this hyperlink.

You will now be on the View FME screen. This screen will list all items of FME recorded against that case.

Select the entry corresponding to the FME received using the appropriate Radio Button

Select ‘Record Receipt of FME’ from the ‘FME Actions’ drop-down menu and click ‘GO’.

On the following screen the ‘FME Type’ field will already be populated with the type of FME

Enter the date of receipt in the ‘Date Received’ field and then click ‘Confirm Receipt’.

You will now be returned to the View FME screen.

Once you have recorded receipt, click ‘BACK’ and you will be returned to the View Case screen.

The Referral Status will now say ‘Pre-Board Check’, ‘Scrutiny’, ‘LCWRA Filework’ or ‘TI Check’ . The FME should be linked to the Case File (if no Case File exists, one should be created) and passed to a Practitioner for their continued action.

11.4 Receipt of Late FME

If the requested FME is received after the BF has expired, it must still be recorded on MSRS without delay. To do this, navigate to the View FME screen (as explained in section 11.3), selecting the item of FME that is showing as not returned. You should then select Update FME Record from the FME Actions drop-down menu and click Go. On the screen that follows enter today’s date in to the Date Received field and click Record Receipt. You should now progress the Referral as indicated by the Referral Status.

11.5 Recording Receipt of Unlisted FME

Receipt of unlisted FME is recorded as follows:


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Navigate to the View Case screen for the appropriate Referral.

Select the appropriate Referral using the radio button and select ‘View FME’ from the Referral Actions drop down menu, then click ‘GO’.

Once on the View FME screen, select ‘Record Receipt of Unlisted FME’ from the ‘FME Actions’ drop-down menu and click ‘GO’.

On the following screen the ‘FME Type’ field will display ‘Other’. Enter the date of receipt in the ‘Date Received’ field and click ‘Confirm Receipt. You will now be returned to the View FME screen.

Click ‘BACK’ to be returned to the View Case screen.

Having recorded the unlisted FME on MSRS, you should now progress the Referral as indicated by the Referral Status. If the Referral Status has progressed to Pre-Board Check, the item of FME (and Case File, if available) should be passed to a member of the Resource Team for progression.

Note that receipt of unlisted FME cannot be recorded against TI or WFHRA Referrals. For guidance on FME processing in relation to TI Referrals please refer to the MSRS Terminal Illness Related Referrals Administration Guide. For guidance on FME processing in relation to WFHRA Referrals please see the MSRS Resource Team Guide.

11.6 FME received on Questionnaire Referrals

If FME is received, e.g. a letter from a GP, whilst we are awaiting receipt of a Questionnaire you should record receipt of unlisted FME against the open Q Referral. You should also create a Case File if one does not already exist.

MSRS does not currently trigger OCP action against Q Referrals. For this reason, the FME and a Clerical ESA85a should be linked to the Case File. This should then be passed to a practitioner for Filework.

11.6.1 Client Accepted, Treat as LCW or in Support Group

If the practitioner has provided a final medical output on an ESA85A, you should withdraw the Q Referral, selecting Other from the drop down menu adding the following to the withdrawal reason box “FME received on Q referral, offline advice given in ESA55’. You should now issue letter NR1/NR1-W (available on LiveLink) to the Claimant explaining they no longer need to complete/return the Questionnaire.

You should then return the Case File and any associated paperwork to the referring customer office.

11.6.2 HCP unable to advise

If the practitioner indicates that the questionnaire is still required you should place the Case File in to the BF to await receipt of the Questionnaire.


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12. View Action Prompts

The View Action Prompt option is found on the left hand side of the MSRS page and provides a list of further action needed on referrals. These actions can be in response to changes made by the Customer to Claimant details or they can be triggered by workflow progression.

View Action Prompts must be checked on a daily basis and actioned accordingly.

Once View Action Prompts link has been selected:

You should not make any changes to the Owning Office field.

Select your Back Office from the drop down menu. Although the MEC drop down menu is also available, this should only be used by members of staff working at that particular MEC

Select Action Prompt Type (mandatory).

12.1 Change DV Address

All entries in this area will be actioned by the Resource Team. Please see the MSRS Resource Team Guide for further information.

12.2 Update Case File

When certain Claimant details are changed on MSRS and the Referral is identified as having a Case File within MSRS, the Case File will need to be updated accordingly. This will occur when any of the following fields have been changed on MSRS (more than one field change per NiNo can appear under one View Action Prompt eg Surname and PV could be changed together):

Surname Forename

PV Status Customer Office

Note while a Case File is with a Practitioner undergoing Filework you may not be able to update it. You should carry out the Update Case File activity when it has been returned. You should NOT clear the Update Case File action from the View Action Prompt list until you have carried out this action.

Once this has been done select the corresponding tick box on the Update Case File screen, followed by the Confirm Actioned button.

Note: to specifically identify where the Case File is, you will need to go to the View Case screen to view the current Referral Status. To do this you should copy the NINO and carry out a Client search. Where the Referral Status indicates that the referral has progressed beyond Filework, you should inform the appropriate team that there is a change, for example, if the Referral Status is DV Allocation, you

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should inform the Resource Team of the NiNo. Do not clear the Update Case File from the list.

In order to discover any changes that have been made, once the case file has been located, the details listed above should be cross referenced on MSRS with those on the case file. The case file should be updated where necessary.

If once the file has been located and there is no difference between the information on MSRS and the Case file, clear the Action Prompt.

12.2.1 Change to Surname

When a change has been made to the client surname it may not always be possible to locate the case file. Where this is the case, the details should be passed to the Scrutiny Team Leader.

The Team Leader will then, where available check previous medical outputs to ascertain the previous surname. Where no previous outputs are available, the Team Leader should contact the BDC to confirm the previous name.

Note: This activity should be restricted to the Scrutiny Team Leader to avoid duplication.

12.3 Relocate Case File

All entries in this area will be actioned by the MCAs. Please see the MEC Administrator’s Guide for further information.

12.4 Progress Case File

This option displays all referrals at the following referral status;

Extract Case File

Extract Case file Pending Exam

The table can be sorted by clicking on one of the headers. The headers are as follows:

Client NINO

Surname

Referral Category

Last Progressed Date

Only 10 entries are viewable on a single page at any one time. If there are more than 10 entries you can view them by clicking Next. If you select File then Print from the Internet Explorer window, you can print each page of the list.

This list must be checked daily.

Where a referral has timed out because FME has not been received, a questionnaire referral with a supporting case file has not been returned, or the case


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has been withdrawn the Claimant details will now appear on this list.

All of the files stored in the BF should be extracted first by cross referencing with this list. Some of the case files on the list may not be in the BF at this point and these should be disregarded for the time being without confirming the case file has been extracted.

Once you have extracted the Case File for those that are present, you will need to clear the ‘Extract Case File’ Referral Status. This is done as follows:

Select the appropriate Referral from the list using the radio buttons then click ‘View Referral’.

You will now be taken to the View Referral screen.

Click the ‘Extract Case File’ Referral Status hyperlink. This will take you to the Confirm Case File Extracted screen.

Click ‘Confirm’ to confirm that you have extracted the Case File.

You should not remove the referral from the Extract Case File list unless you have located the file.

Alternatively, you can clear the Referral Status from the View Case screen by clicking on the ‘Extract Case File’ hyperlink and following the process described above. When you have done this, the system will update the Referral Status which will indicate the required Case File location. This will generally either be the filework practitioner or the customer office.

The Scrutiny Team Leader should ensure that the Progress Case File List is checked daily for any referral that has remained in this list for more than two days for investigation.

To locate the file, check the most recent Medical Output, if the status of the output is a Draft, the case file will be at audit. If the output is not a Draft the case file will be with the DV administrator.

If the referral status is at Audit or DV Allocation contact the relevant section and ask them to take the appropriate action. For referrals at MEC, MCAs will locate the case file and clear the prompt.


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13. Change of Circumstances

The DWP may now update MSRS with any Change of Circumstances (including withdrawals) without the requirement to notify Atos Healthcare. Where you are contacted by a referring BDC to carry out any change of circumstances, the JCP member of staff should be advised to carry out the action themselves on MSRS.

Any requests for Change of Circumstances received on paper should be actioned on MSRS and referred to the Scrutiny Team Leader for escalation.

Note: The only exception to the above, is in connection with the alteration to client NINOs. Any change required to a client NINO should be sent by the DWP to the LSA as per the agreed process.

The exceptions to this are Client Dead and change of diagnosis. See section 13.1 for details on how to process these changes.

13.1 Client Dead

If the DWP are notified that a claimant is deceased whilst there is a live referral, they will withdraw the case from MSRS themselves, selecting ‘Client Dead’ as the withdrawal reason. They will then follow this with a courtesy call to Atos Healthcare to inform them that this case has been withdrawn because of this reason. In this instance you should ensure the case has been withdrawn by the DWP on MSRS and ensure any action required by Atos Healthcare (eg Action Prompt – Progress Case File) are dealt with promptly.

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14. Back Office contacted by Clients

14.1 Request of Welsh, Braille or Large Print IB/ESA50s

Should a Claimant contact the Back Office requesting a Welsh, Braille or Large Print copy of the ESA50/ESA50A Questionnaire they should be directed to contact the office that deals with their benefit claim.

Once the request has been received at the Customer office they will issue the requested version of the Questionnaire advising the Claimant to return it to the Medical Services Back Office. The original 43 day BF will continue to apply e.g. if the request is received on day 20, the Claimant will have 23 days to return the completed Questionnaire.

14.2 Questions regarding Questionnaire completion

Should a Claimant contact the back office asking for clarification surrounding the completion of any paperwork they should be directed to contact the customer office that deals with their claim.

Under no circumstances should an Atos Healthcare administrator give guidance to a Claimant on the completion of paperwork.

14.3 Data Protection Act related requests

If a Claimant contacts the Back Office and asks for copies of all data held about them under the Data Protection Act you should inform them that all Data Protection Act requests must be submitted to the JCP. You should tell the Claimant to contact the office that deals with their claim.


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Appendix A - Valuables

Birth certificates

Marriage/civil partnership certificates

Adoption certificates

Death certificates

Divorce/dissolution of civil partnership decrees

UK gender recognition certificates.

Power of Attorney, Court of Protection

Change of Name

Christening/Baptism Certificate

Probate

Any legal document

Passport

Immigration Certificate

Cash

Cheques

Giro Cheques

Bank Paying in Book

Cheque Book

Cash point Card

National Insurance Card

Driving Licence

Building Society book

Bank Savings book

Local Payments

Coupons and Gift Vouchers

Travel Tickets and Warrants

Loose National Insurance Stamps

Benefit Order Books

Savings and Postage Stamps

Other items of Direct Monetary Values

Premium Bonds

Share Certificates

Gender Recognition Certificates

Tenders

Company/Business Accounts

Legal Documents

Foreign Identity cards

Pension Documents

Council Tax book

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Union Card

Travel permits

Medical Records Insurance Documents

Handicapped Card

Phone bills

Registered disabled green card

Court Summons

Rent books

P45

Forces Certificate

Payslips

TV Licence

Med 5/10

D:\Documents and Settings\49465n\My D

D:\Documents and Settings\49465n\My D


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Appendix B - Case File Creation

The situations where a Case File (ESA55) will require to be created are summarised below. Note you should only create a Case File if MSRS indicates that one is required and you are certain that one does not already exist.

Receipt of Further Medical Evidence

Receipt of a Questionnaire

Receipt of a DS1500 (TI Referrals only)

Receipt of a letter from the Client (treated as FME)

A Case File is created as follows (you must use the Return of Supporting clerical Documents side of the ESA55):

Benefit Type

o Tick the appropriate Benefit Type

Special Indicator/PV Marking

o If the Client is PV you should place a chequered stamp here in black ink

Return Documents To

o Enter the name and ID number of the referring Customer Office

Customer details

o Enter the Clients NINO

o Enter theirs Surname and indicate what their title is

o Enter any other names that they use e.g. First Name

Referral Progress

o This is used to clerically track the Referral following scrutiny or Pre-Board Check

Notes

o You should enter details of any Special Needs in this section

MSRS Registration and Scrutiny Guide 3b (draft)

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Appendix C - NINO Discrepancy Cover Sheet

This cover sheet should be used when returning an ESA55 and Questionnaire to a Referring Customer Office when a NINO discrepancy has been identified.

NINO Discrepancy Cover Sheet.doc


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Appendix D - ED Process At a Glance

Below is an At a Glance document that serves as a desk aid to the ESA ED Admin Procedures.

ESA ED Referrals Process.doc


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Observation form

Please photocopy this page and use it for any comments and observations on this document, its contents, or layout, or your experience of using it. If you are aware of other standards to which this document should refer, or a better standard, you are requested to indicate this on the form. Your comments will be taken into account at the next scheduled review.

Name of sender: ________________________ Date: _____________ Location and telephone number:____________________________________

Please return this form to: The Process Design Team