Claims and payments

System change: learning new ways of doing things

Some of the improvements we’ve introduced mean some providers may need to learn new ways of doing things or stop doing some of the things they’ve done before.  

We acknowledge change can sometimes be hard, and adapting to different processes can take some time. We are committed to the changes we’ve introduced because participants, providers, the disability community and the Australian Government told us these were improvements they wanted to see and we needed to make. 

We removed service bookings because participants wanted more flexibility in how they could use their funding. While service bookings gave funding surety to providers, they limited choice and control for participants. 

We introduced 6 new support categories and lifted the budget to the category level, so that participants could have more flexibility in how they purchased their supports. We will still have stated and flexible supports, and the line items for claiming does not change. 

Providers should continue to use the existing support item descriptions or codes to make their claims. These descriptions and codes will automatically point to the relevant budgets in our new computer system.

System controls: protecting participant plans

The Australian Government is committed to protecting the consumer rights of participants and ensuring reasonable pricing practises. 

We have improved business intelligence in our new computer system. This means we can better understand when a participant’s spending pattern is higher or lower than usual. We will work directly with them to make sure they have the funding, supports and providers in place to support their needs and goals. 

Increased plan security with a new process called my providers, for participants to record their longer-term relationships with providers and when some or all of their supports are Agency-managed. When recorded as a my provider, participants are letting us know that the provider can receive payments for claims on their NDIS plan.  

We have introduced an additional claim validation process for participants, so they can review payment claims submitted for their plan by providers who are not recorded as their my provider for Agency-managed supports. 

We have improved our quality assurance processes and the way we manage and resolve payment claims, for faster and more consistent outcomes. We want to make sure that all claims for payment are valid, can be claimed and are recorded correctly. 

Providers can be confident with the introduction of quality control measures including: 

• consistent checks on claims 
• removing service bookings 
• introducing my providers. 

We are all contributing to safeguarding the Scheme. 

Using the new system: tools and resources

In addition to the information on this website, we have a range of tools and resources available to help providers prepare and adjust their ways of working.

This includes:

• Technical Documentation for providers: how to use the new system
• Journey maps
• Checklists
• User guides
• Information packs
• Attend an information session
• Access the provider learning environment
• Claims and payments troubleshooting

Using the new system: Bulk payment claims

As participants and their plans move to our new computer system, providers will not be able to use the single line-item claim function.

All claims will continue to be made in the myplace portal with the same service and support details used now.

Claims will need to be made using the:

• Bulk Payment Request template (CSV 1KB)

Providers should consider adjusting their business practices to submit all single claims via the bulk upload process. If providers use the bulk payment request template, they don’t need to understand if a participant has an NDIS plan in our new computer system because all claims should be made through the myplace provider portal. 

Using the bulk uploads process will also reduce the likelihood of providers receiving single claim error messages, duplicating processes, and experiencing payment delays. 

Providers can watch our video on making bulk payment claims to learn more: 

Using the new system: My providers

Payments – for providers recorded as a my provider

Payments for Agency NDIA-managed plans and supports from my providers are generally paid within 2 to 3 business days.

Payments – for providers not recorded as a my provider

When a payment claim is made: 

• on an NDIA-managed plan or support and 
• from a provider who is not recorded as a my provider 

We will check with the participant or their nominee by SMS to make sure: 

• the support was agreed to 
• the claim has valid details 
• the participant or their nominee has agreed to the support. 

Valid claims on Agency-managed plans or supports from providers who are not recorded as a my provider generally take 10 days to be paid. 

Claims from providers for specialist disability accommodation, home and living supports and behaviour supports who aren't listed as a my provider for the participant's plan will be automatically rejected. 

Claiming for services after the end date of plan

Claiming for services after the end date of plan

Providers need to make sure claims are in line with the participant’s plan dates and claim using the bulk upload template.

Previous plan managers need to make sure they submit any claims before the end of their plan management period with a participant. New plan managers can submit claims for entire plan period if they are recorded as plan manager role.

Claims for participants who have left the NDIS

Providers can still claim for supports delivered before the participant has left the NDIS. We recommend claiming within 90 days from the participant's date of leaving the NDIS, or of the participant's death.

If a provider is claiming for supports delivered after the participant has left the NDIS, the claim will be rejected, and the provider will need to contact the Agency to have it reviewed.

The NDIS Bereavement Addendum lists support items that providers can claim after an NDIS participant has died. 

More claims and payment support

Read more about troubleshooting common claims and payments errors and rejections.