Claims and payments

Providers should use the myplace provider portal to manage all their financial transactions with the NDIA, including:

• Making payment claims
• Raising payment enquiry tickets.

There are no changes to how providers make claims in the myplace provider portal, support item descriptions, or the codes used to make claims. 

One new support type and 6 new support categories have been added to NDIS plans in our new computer system.  

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.

To make sure our language is consistent across NDIS plans and portals, the name of the support catalogue item in the plan will be the same name in the participant and provider portals.  

Pricing arrangements and limits are the same, regardless of whether a participant’s plan is developed in our new or old computer system. Providers can keep up to date with the regular pricing updates.

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 need to be made in the current 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:

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

Providers can cancel claims in the myplace provider portal for participants who have a NDIS plan in our new computer system.

Providers who make a mistake with a payment request can cancel the claim, when it is “pending” or “paid”. 

Providers should follow the myplace provider portal step-by-step guide to cancel their claim.

The process to cancel these claims in the myplace portal is the same for all NDIS plans, regardless of whether they are in our new or old computer system.  

If a claim is rejected, providers will see advice in the myplace provider portal which shows the reason why the claim has not been processed.

The majority of claim payment errors can be corrected by providers in the myplace provider portal.

For example, administrative errors like wrong dates, a duplicate claim, missing banking or ABN details, or the claim includes a unit price that is more than the maximum price.

If a provider's claim is rejected, or if they receive an error message, they can refer to the bulk payments request self-help guide for more information:

• Bulk payments request self-help guide (PDF 1.3MB)
• Bulk payments request self-help guide (DOCX 2.3MB)

Providers who are supporting an NDIA managed participant with an NDIS plan in the new computer system, and are not recorded as a my provider, will not receive an error code while their claim is being checked. The claim will remain as ‘open’ until it is paid or rejected. This means some claims may have an ‘open’ status for up to 10 days.

When we check with a participant, and they tell us they have not received a claimed support, we will pause the payment and review the claim. Claims that are not authorised for payment will be marked as ‘rejected’ in the portal.

When a claim is rejected, providers won’t be able to see the participant’s name. The rejected claim will display the participant’s NDIS number only.

Claims from providers for Agency-managed 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.

Self-managed or plan-managed specialist disability accommodation and behaviour supports must be delivered by providers who are registered with the NDIS Quality and Safeguards Commission.

Plan managers can only submit claims for supports delivered within their current plan-management period.

Plan managers need to make sure they submit any claims before their plan management period on a participant’s plan ends.  

Providers can still claim for supports purchased before the participant has left the NDIS under a service agreement. 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 services 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.

Follow this checklist to help solve queries you may have about claims and payments.