Making a claim from the NDIS
Go to the Handbooks Page to download the Making a Claim handbook. (Free for NSW sole traders and NDP Sole Trader members.This email address is being protected from spambots. You need JavaScript enabled to view it. to find out more.)
Summary
Necessary steps before submitting a Payment Request
Appropriately RegisteredProviders will only be able to make Payment Requests for support categories that they are registered to claim from. For example, a provider of in-home domestic help will not be able to make a Payment Request to a participant’s Assistive Technology support category. Providers need to check with participant’s if their NDIS plan contains the support category for which they intend to claim from.
Adding or updating registration groupsProviders can view the registration groups that they are currently registered for as well as adding and updating new ones. Providers can access this by clicking the Registration Details tile in the provider portal. Different registration groups will have different provider requirements. These requirements determine whether or not a provider is adequately skilled and experienced to deliver certain supports and services. View the Guide to Suitability.
Service AgreementBefore a provider can submit a Payment Request, providers should have a Service Agreement in place with the participant. The Service Agreement should set out the type, frequency, unit price and expected overall cost of the services that they will be providing to the participant.
How would a sole trader use the Payment Request functionA sole trader would create and submit Payment Requests just the same as any organisation would. A larger organisation is more likely to use the ‘Bulk Upload’ function within the Payment Request system as they will be dealing with a greater volume of invoices. Sole traders can also use the ‘Bulk Upload’ function if they will be making a lot of Payment Requests.
Approved Service BookingTo submit a Payment Request through the Provider Portal, providers will need to have an approved Service Booking in place with the participant. The provider will need to place the Service booking for the agreed upon service and price and the participant will need to approve it through the participant portal. Until the Service Booking is approved by the participant, the provider will not be able to submit a Payment Request. In the first instance, providers should contact the participant if there are issues relating to Service Bookings. If they are unable to resolve the issue, providers can contact the NDIA helpdesk on 1800 800 110.
Correct Line Item (if applicable)If providers specify a line item in the Service Bookings they create with participants, they will only be able to submit a Payment Request that includes the specified line item. Providers need to consider what is involved with specifying line items in a Service Booking, especially in relation to unit prices.
Payment Request DatesThe Payment Request system in the provider portal will reject Payment Requests that have a support start date and/or a support end date that fall outside of a single NDIS plan period. This means that providers who are providing services to participants across two plan periods will need to separate the relevant invoice into two parts, each containing service delivery dates within a single plan period.
How does the NDIS Process Payment Requests?
Who checks Payment Requests I submit?Payment Requests that providers submit will be verified to confirm that there is a matching Service Booking, the correct line item is used (if applicable), the service delivery dates are within the participant’s NDIS plan period and that there is sufficient funding in the participant’s NDIS plan. This verification process is completed within the systems of the provider portal and, except in very limited circumstances, will not be assessed by an NDIS employee.
What happens after I submit a Payment RequestIf a Payment Request has been successfully submitted, it will enter the pending status. This indicates that the details entered by the provider are correct and that there is sufficient funding in the participant’s NDIS plan. It will take approximately 24-48 hours for a Payment Request to move from the ‘pending’ state to the ‘paid’ state. At this point, the funds will be released to the provider's nominated bank account.
Funds from Payment RequestsThe funds from successful Payment Requests will be released to the nominated bank account of the provider approximately 24-48 hours after submitting the Payment Request. Providers will receive a remittance advice in their provider portal email inbox that will document the details of the successful Payment Request. Transfers will enter the providers bank account with a reference attached showing that it is a payment from the NDIS.
If providers submit Payment Requests in relation to participants from different states or territories, they will receive the funds into their bank account broken down per state. For example, a provider can submit a Payment Request for a participant who lives in the ACT and a participant who lives in NSW and the provider will see two separate transfers into their account. Each separate transfer into the provider’s bank account will have a reference indicating which state the participant lives in.
Receiving and reconciling payments
Matching Payment AmountsProviders should compare the amount they have submitted as per the Payment Request and the amount that was transferred to their bank account. A received amount that differs from what the provider entered in the Payment Request may indicate that the unit price was capped. Providers can go back and look at what line item they have entered as they may have used a line item with a lower unit price than they intended.
Multiple PaymentsProviders that make multiple Payment Requests in one day will receive one lump sum transfer from the NDIS. The remittance advice that is sent to the provider will indicate the breakdown of the total amount sent to the provider. Again, the provider needs to check that the amounts on the remittance advice match the amount they have received.
Remittance AdviceProviders will receive a remittance advice from the NDIS for all successfully submitted Payment Requests. The remittance advice will indicate the line item number that was used as well as the quantity and unit price. Providers can compare the claimed amount as it was entered in the Payment Request and the actual amount paid to the provider.
Payment AllocationProviders need to make sure they are allocating the funds received from the NDIS to the correct participant. Providers can use the remittance advice to confirm which payments have been received for which participants.
What to do if a Payment Request is unsuccessful
Providers should speak with the NDIA helpdesk first if they are experiencing payment issues. If providers are unable to have their issue resolved by the NDIA helpdesk, they will need to then contact the Provider Payments team. The NDIA helpdesk is likely to make the enquiry to the Provider Payment team on the Providers behalf, but it is good practice to double check that this has happened.
Pages 43-57 of the Provider Portal step-by-step guide provides further information on the Payment Request process.
