How to future-proof your NDIS business amid industry change

The NDIS has changed a lot over the past decade. It’s opened doors for sole traders, contractors, and small providers – and with that kind of growth – change tends to be constant. Finding ways to adapt (while still keeping participants at the centre of what you do) is part of the job, even if it’s not always easy.

At the same time, there’s a lot of chatter out there. Opinions, predictions, rumours – you name it. It can be hard to figure out what’s actually worth paying attention to, and what’s just background noise. So, the real question becomes: What should you focus on to keep your business steady, even as the NDIS continues to evolve?

Lately, most of the conversation has been about registration, compliance, foundational supports, and pricing changes. These things do matter, and they’ll shape the way providers work in the future. But there are also simple, practical things you can do right now to make your business more resilient, so that if changes do come, they don’t throw your whole operation off course.

You can think of the areas below as your “steadying points” - the things that help you stay grounded and ready for whatever happens next.

Plan for change

Like any business, having a solid plan is essential. A good business plan sets out your goals, expectations, and opportunities – it’s your foundation for success.

Marketing is part of that plan, but in the NDIS space, it’s just as important to prepare for change. Think ahead: what happens if regulations shift, funding changes, or unexpected challenges arise? Clear procedures and backup plans mean you won’t be left scrambling when things get tough. Instead, you’ll have a roadmap ready to guide you through.

Think about how prepared you are for both growth and challenges:

Record-keeping never gets old

Good record-keeping is the backbone of compliance and quality service - so much more than just a box to tick. For providers, following the NDIS record-keeping requirements is part of everyday business.

We all know paperwork takes time, and that should factor into your expectations around caseloads. Accurate, up-to-date records help you deliver quality services, adhere to NDIS requirements and build trust with clients and regulators.

Picture an audit tomorrow - would your records pass the test? Are they thorough, secure and easy to update, and could your system adapt if requirements change?

Technology is your friend, with some conditions

The right technology can make life easier. From streamlining admin tasks to helping you stay on top of compliance, technology can save time and reduce stress. But if you’re using cloud-based solutions, make sure your data is stored in Australia which is a key requirement for NDIS compliance.

And while technology is helpful, it’s not without risks. AI tools, for example, can be great for efficiency, but they also raise questions about accuracy, bias, and privacy. When you’re dealing with participant information, privacy should always come first. Before adopting any new technology, check how it handles sensitive data and whether it meets NDIS standards for security and confidentiality.

Think about where technology could lighten the load in your business.

Learning never stops, make it a priority

The NDIS space is always evolving, and staying ahead means keeping your knowledge up to date. Investing in ongoing professional development helps you stay across best practices, emerging trends, and new regulations – and that positions you as a trusted, adaptable provider.

Think of learning as a long-term investment in your business - it’s about building confidence, credibility, and resilience when change happens.

Ask yourself:

Make feedback part of your business DNA

Open communication with clients is good practice, and in fact, it’s a requirement under the NDIS Practice Standards. Providers must have a clear, accessible process for managing feedback and complaints, and show they act on it.

Regular feedback helps you understand what’s working, what’s not, and what clients really need. And it shouldn’t only happen when things go wrong (or right). Building a transparent, ongoing feedback process – and having clear steps for how you’ll respond means you can adjust services proactively, avoid bigger issues, and stay compliant. It also shows clients you value their voice, which builds trust and loyalty.

Consider whether feedback is helping you improve or just ticking a box:

Advocate for your clients

Advocacy is part of what makes the NDIS work. Standing up for your clients’ needs in the industry and in your day-to-day business dealings helps ensure their voices are heard. It can even influence policy discussions and keep changes focused on what matters most: people.

A person-centred approach is a conscious choice that takes commitment, vulnerability, and continuous improvement.

Ask yourself ‘Are my clients’ needs at the forefront of every decision I make?’

Stay ahead and stay strong

Change in the NDIS isn’t a matter of if, it’s a matter of when. And while change can feel daunting, it’s part of what makes this sector dynamic and impactful. The providers who thrive aren’t just reacting - they’re planning ahead, staying informed, and keeping people at the centre of everything they do.

By building strong foundations you’ll not only weather change, you’ll lead through it. That’s how your business stays strong, and your clients get the support they deserve.

As the NDIS evolves, at My Plan Manager we’ll stay focused on what matters most - making the finance side simple for you and your clients, so you have one less thing to worry about.

How My Plan Manager protects you from NDIS fraud and what you can do too

Fraud is a growing concern for everyone, and scammers are constantly finding new ways to target people online. As Australia’s largest plan manager, protecting your data and your National Disability Insurance Scheme (NDIS) funding is our top priority.

We’ve put strong measures in place to prevent fraudulent activity and pick up on honest mistakes (like incorrect line items in claims), so you can feel confident your funds are being managed properly and securely.

Here's what we do to keep your information safe – and some simple steps you can take to protect your data as well.

Accreditation and training

We take every precaution to protect your data with systems that meet (and exceed) industry standards. We’re proud to hold ISO 27001 accreditation, the globally recognised standard for information security management. In plain terms, that means we follow strict, audited processes for how your information is stored, accessed, and protected.

But education is just as important as technology. We invest heavily in training our team to spot and manage fraudulent communications, with regular testing to keep their skills sharp.

Every time you or a provider contacts us for private information, our staff follow precise proof-of-identity checks. And, in the rare event privacy is breached, we have robust policies in place to minimise any risk and prevent fraud.

Client-focused technology

We’ve invested in powerful, client-focused technology designed to keep your NDIS funding safe and compliant. Every claim we receive goes through more than 30 automated checks to ensure payment integrity and make sure it adheres to the NDIS Pricing Arrangements and Price Limits.

This technology works hard behind the scenes, blocking more than 250,000 non-compliant claims, and preventing more than $310 million from being incorrectly paid in the last financial year alone. For you, that means more of your budget stays available for the supports you need.

As Australia’s largest and leading NDIS plan manager, vigilantly monitoring for fraudulent activity and incorrect transactions is a critical part of what we do, so you can feel confident your funds are protected.

Working with the National Disability Insurance Agency

We’re proud to play an active role in protecting the integrity of the NDIS. That’s why we work closely with the NDIS Quality and Safeguards Commission and regularly collaborate with the Fraud Fusion Taskforce – a multi-agency initiative led by the National Disability Insurance Agency (NDIA) and Services Australia.

Using smart technology that brings together data, analytics, and reporting, we’re able to share meaningful insights with these bodies to help shape strategy and strengthen the fight against fraud. We’re committed to preventing organised crime, protecting participants, and helping to keep the NDIS sustainable for the future.

What you can do to help protect yourself

With choice and control at the heart of the NDIS, we want you to feel confident and empowered to safeguard your plan.

Here are some simple actions you can take to do just that:

Choose SMS notifications

Opt in to receive SMS alerts every time a provider submits an invoice. These messages show who’s claiming from your plan and how much they’re charging. If something doesn’t look quite right, or you have a question, contact us and we’ll help you check it out.

To start receiving SMS notifications, call us on 1800 861 272 (8am-5.30pm SA time, Monday to Friday).

Check your consent permissions

We only share your details with people who you’ve officially authorised through ‘Consent to share’ paperwork. Keeping this up to date helps protect your privacy.

Not sure who you’ve given consent to or need to make changes? Call us on 1800 861 272 and we’ll help.

Keep your contact details up to date

Make sure your phone number and email address on our files are always current so you never miss important communication from us.

Never share your MyGov log in details

Your log in details are private, and you shouldn’t share them with anyone. If you receive suspicious requests to access your accounts, let us and/or the NDIA know immediately.

Monitor your spending

Regularly check the My Plan Manager client portal to track your spending and confirm your supports are being claimed correctly. If something looks unusual, or you want help verifying invoices, contact us.

Keep your devices secure

Avoid sharing your phone, laptop, or tablet with anyone. Others may be able to access your private accounts and change your personal information if they have access to your devices.

Report suspected fraud

If you think someone is misusing NDIS funds you can report suspected fraud or non-compliance by calling the NDIS Fraud Reporting and Scams Helpline on 1800 650 717 or emailing fraudreporting@ndis.gov.au.

You can contact the NDIS Quality and Safeguards Commission too.

We’re here to help

At My Plan Manager, we’re committed to protecting your data, your funding, and your confidence in the NDIS. With strong systems and a dedicated team, we’re working hard every day to keep your funding secure, so you can focus on what really matters: living life your way.

If you ever have questions or concerns, we’re only a call or email away. You can email us at enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday. Together, we can keep your plan safe, and your NDIS journey stress free.

Sharing your NDIS plan with providers

When you start working with a provider, one of the first things that comes up is your National Disability Insurance Scheme (NDIS) plan. It’s the roadmap for your supports, and sometimes providers need a closer look to make sure everything goes smoothly.

To deliver services under the NDIS, they’ll usually have to confirm you’ve got the right budget and understand the rules in your plan about how money can be spent.

That’s normal, and they’ll usually talk to you about it. But here’s the big question: what do you actually need to share, and how do you do it without feeling pressured?

Let’s break it down together.

Before you start working together

Before you sign on with a provider, they should be up front about what they’re offering – what item or service they’re providing, which budget category it’s claimed from, how often you’ll receive it, and what it will cost. This is usually written down in a service agreement.

Providers are also likely to check you have the correct budget available, and they may ask about the funding periods in your plan. These can add extra rules (and complexity) around when money can be spent, and it’s easy to feel a bit lost at first.

If you’re unsure what funding periods mean, we’ve explained them in more detail here. In short, they’re blocks of time that split your total NDIS budget into smaller chunks, and they’re usually unlocked every three months.

Think of each funding period like a mini plan that needs to be managed carefully – particularly when you have multiple providers claiming from the same budget categories. If things aren’t tracked properly, funds can run out.

Because of this, it’s a good idea to have a new service agreement for each funding period. This helps you keep track of spending as unspent funds are rolled over, and as pricing, circumstances, or services change. So don’t be surprised if your providers check in about your budget more than once – they’ll usually do it at the beginning of each new service agreement.

One more thing to consider is that some services in the NDIS cost more up front when you and a provider first start working together. The National Disability Insurance Agency (NDIA) says funding periods allow for these higher starting costs, but if your budget looks tight, it’s best to chat to your providers or potentially request a plan variation or a review from the Agency.

Can I share information about my plan through the NDIS myplace portal?

Yes – you can share your plan with providers through the myplace portal, which will allow them to see basic information like your NDIS number, date of birth and goals.

What they won’t usually see (unless they’re your support coordinator) is your budget information. That part is important for planning services, so the easiest way to share it is by having a quick conversation at the start of each new service agreement.

If you’re not comfortable sharing your whole plan, that’s ok, you can just share the parts that matter for the service. Keeping it focused helps you stay in control, while giving providers what they need to do their job.

My provider has asked to see my entire plan. What do I do?

First things first: it’s your choice whether you share your whole plan. You’re not required to, and in most cases, it’s better for providers to ask only for the information they need. The exception to this is support coordinators – with your consent, they do need to see your full plan to do their job properly.

Most providers act with honesty and integrity, but we know there’s a worry that some might ask to see your whole plan just so they can check what the maximum budget available is. If that makes you uncomfortable, you can absolutely say no. Instead, you can share only what’s relevant – like the budget categories for their service and how much support you’re prepared to hire them for.

If they push back, ask why they need that information. You have every right to keep your plan private. A good provider will explain what they need and why, so you can make an informed decision.

Remember, a good provider will be clear about what item or service they intend to provide, the budget and category it’s claimed from, the frequency and cost. They’ll check this aligns with your plan to avoid overservicing and to make sure claiming stays predictable.

Open communication matters, especially when you have multiple providers involved. It helps avoid overspending and keeps your supports running smoothly. Providers are expected to uphold continuity of service under the NDIS Practice Standards, so checking in regularly is part of doing things right.

Your plan is yours - only share what feels right for you and always ask questions if you’re unsure.

We’re here to help

If you’re unsure about sharing your plan or just want a second opinion before doing so, we’ve got your back. Our team is here to make things easier and help you feel confident about your choices. You can reach out to us any time here.

The cost of NDIS price cuts

Has it felt like keeping your business afloat gets harder every year? Well, unfortunately, you're not alone. Rising inflation, staff wages, insurance premiums, and even the cost of keeping the lights on and the car running, all adds up. And if you're in the business of supporting National Disability Insurance Scheme (NDIS) clients, the figures can look even tougher.

Add to that the growing admin burden of audits, compliance, and policy changes that shape your day-to-day, and the cost of care keeps growing.

But most people don’t choose this work for the money. They do it because they care deeply about improving lives – and we’re willing to bet you’re one of them.

Many providers go above and beyond, sometimes doing unpaid work just to keep the doors open and not let their clients down. That’s admirable, but it's definitely not sustainable. So, when the Australian Government recently announced price cuts to a number of NDIS services – including some therapies – it’s no surprise there was pushback.

You can read more about the rule changes that brought these cuts in here, but you’ve probably heard about the concerns from a number of peak bodies and providers across the sector anyway.

According to the National Disability Insurance Agency (NDIA), the latest round of price cuts has been geared in favour of participants and designed to keep the Scheme viable. The Agency says it’s all about tackling inflation and creating fairer and more equitable pricing that’s more in step with broader market rates.

But there's a major factor missing here – making it harder for providers to operate means fewer providers overall. That means less choice for participants, fewer options, and less control over the supports they need. And isn’t choice and control what the NDIS is supposed to be all about?

Pushback from across the NDIS sector

The Australian Physiotherapy Association (APA) has called for action from the Federal Government, saying recent price cuts to physiotherapy have stretched NDIS providers to breaking point. It says experienced clinicians are likely to exit the sector, reducing the availability of support for participants.

“We must act now to ensure the viability of our profession and protect the people we serve,” says the APA.

Occupational Therapy Australia reports the price freeze in its domain has left hundreds of occupational therapy businesses ‘on the brink of financial ruin’, with thousands of NDIS clients at risk of being left without care.

Meanwhile, the Australian Greens have called on the Federal Government and the NDIA to ‘engage in urgent and meaningful consultation with health professionals and disability support providers’.

Senator Jordon Steele-John, Australian Greens spokesperson for Disability Inclusion and the NDIS, says the pricing changes will affect the quality and accessibility of services for NDIS participants, and could result in professionals leaving the sector altogether and some provider organisations being forced to shut their doors.

Operating in the NDIS comes with different challenges

Teresa Wilkinson, a physiotherapist from Move For Life Therapy, says pricing in the Scheme hasn’t kept pace with growing operational costs or inflation.

“Wages, insurance, fuel, and equipment costs have all increased substantially, yet NDIS pricing has not adjusted accordingly,” says Ms Wilkinson. “This growing gap forces providers to operate on increasingly tight margins, risking service withdrawal and reduced availability for participants.”

Ms Wilkinson says providing NDIS supports carries unique obligations that aren’t present in mainstream healthcare, including compliance, high level communication, reporting, and travel – and for providers like mobile physiotherapists, these costs are significant and unavoidable.

“To provide quality care, we work closely with families, support coordinators, and health professionals, which is something less frequently done in a clinic setting, where care may be limited to a straightforward injury,” she says.

“Higher rates are not about overcharging but about reflecting the true cost of safe, compliant, and individualised service delivery. Communicating this transparently to participants and the NDIA helps maintain trust.”

What’s fair NDIS pricing anyway?

The NDIS Quality and Safeguards Commission says fair pricing means there’s no major difference between the cost of a product or service for an NDIS participant and the price applied to other customers. It says if a provider sets a higher price for NDIS participants and can’t justify the difference, they may be in breach of the Code of Conduct which now includes rules about price differentiation.

Providers say there’s sometimes a disconnect between rules and reality.

According to Ms Wilkinson, complex NDIS participants often require longer sessions, more provider travel, and additional reporting – all of which increase the cost to serve. She says higher price limits would make service delivery more sustainable and provider consultation is vital to ensuring NDIS pricing is realistic and fair.

“Lower prices will discourage provider registration and may lead to withdrawal of existing providers,” she says. “For small and mobile services, sustainability under the current price limits is increasingly difficult.”

“If more providers exit, participants will have fewer choices, longer wait times, and reduced access to essential supports. This will particularly affect participants in regional or outer-metro areas. For participants with mobility challenges or those living in regional areas, mobile physiotherapy (and other therapy providers) may become harder to access. Ultimately, this decreases the Scheme’s ability to provide choice and control.”

Ms Wilkinson says many providers have cut back on travel, limited their service areas, and reduced the time they spend on administration and reporting in order to absorb the price cuts and freezes and stay sustainable.

“While these measures may help businesses survive, they could come at the expense of quality participant care, flexibility and access,” she says.

“We continue to provide NDIS supports because we’re committed to helping people achieve their goals, maintain independence, and improve quality of life. Despite the challenges of the current pricing framework, we remain dedicated to participant outcomes.

“While we certainly need to work together to ensure cost efficiency, price reductions do not take into account the real costs of mobile service delivery. Lower prices may stretch participant budgets on paper, but if providers cannot sustainably deliver services at these rates, then access and quality will start to decline.

“Unfortunately, we’re starting to decline to see participants in certain locations that we would have previously covered before pricing changes.”

Sustainable NDIS pricing

Ms Wilkinsons says sustainable pricing in the NDIS isn’t about inflating costs, but instead about ensuring long term access, quality, and choice for participants.

“Recently, it seems there is a clear disconnect, with the NDIA prioritising cost control, the participants seeking quality and choice, and providers struggling with rising costs,” she says. “This can be addressed through genuine consultation, transparent cost reviews, and recognition of different service models.”

“Balancing affordability with sustainability is essential for the long-term success of the Scheme.”

The NDIA is clearly trying to make the Scheme more sustainable, and that’s something we absolutely support. It’s important the NDIS works long term for everyone involved, but sustainability needs to include the people delivering the supports too. This sector is one big ecosystem, and when one part struggles, it affects the whole thing.

Hopefully, future changes will take into account the voices of providers (people like you doing the work on the ground) and find a balance that keeps the Scheme strong and the sector thriving.

Friction-free NDIS claims

Providing safe, beneficial, and caring services to National Disability Insurance Scheme (NDIS) clients is going to be a top priority for any business in the disability sector, but equally important is getting paid. Because, let's face it, as amazing as your services are, you can’t keep delivering them without money coming in (ideally, on time!).

Like with any service, there can be friction points along the way that slow down payment or even stop it altogether. The good news is there's a lot you can do as an NDIS provider to dodge the potential pain points and keep your billing running smoothly.

At My Plan Manager, we check every invoice that comes in against a whole range of National Disability Insurance Agency (NDIA) rules and regulations, as well as Australian Taxation Office requirements, and our clients’ individual plans. This helps make sure everything’s in order before we submit claims to the NDIA for payment.

For more information – and to understand why we sometimes ask you questions about your claims – take a look at this article about the key checks we carry out on every invoice.

But it's not just about having the right information on your invoices, there are a few other things to keep in mind when supporting NDIS participants, things that can make the payment process even smoother.

And, as an added bonus, all these things don't just help your cashflow – they also strengthen your relationships with clients, reduce the risk of NDIA payment integrity audits (more on those here), and help build your reputation as a provider who’s ethical, reliable, and easy to work with.

Read on for our guide to friction-free NDIS claiming that will help keep you, your clients, and your bookkeeper happy.

Check that invoices are 100 per cent correct

Ok, we know we just said that invoices aren't everything, but they're still important enough to deserve the top spot, because even small mistakes on an invoice can delay a claim. If something’s not quite right, we’ll ask you to fix it, so it meets NDIA requirements. To make things easier, we’ve put together a simple guide to compliant invoicing that explains exactly what to include on your invoices to keep everything shipshape and moving smoothly.

Our sophisticated anti-fraud technology is the best in the sector and runs more than 30 automated checks on every claim to be sure the NDIA’s rules are met. Where a claim doesn’t look quite right, our team will flag where you need to correct it before we submit it to the Agency.

But not every NDIS participant has a plan manager or the benefit of this technology, and a small mistake can cause a claim to get held up with the NDIA’s prepayments team and even undo a funding request (when funding’s used faster due to error).

Check the item or service you intend to provide is consistent with your client’s budget

Check your client has the correct funding available in their NDIS plan to cover the cost of the supports you intend to provide and ask what funding periods are included, as these add rules to when a budget can be spent. This is particularly important where a client needs more frequent or longer supports up front – you need to make sure their funding period can accommodate that.

Getting granular and being clear about what item or service you intend to provide, as well as the frequency and cost – and checking that’s consistent with your client’s budget and funding periods –can make claiming more predictable. It's up to your client whether or not they're happy to share their plan with you, but a polite request for only the necessary section can go a long way.

Have a conversation up front with your client about their needs and spending and what it can mean for service provision

If you end up providing a service that's different from what you originally planned (based on your client's changing needs), make sure they understand what’s changing and how it might affect them.

For example, if you’re claiming from Assistance with Social and Community Participation under Core Supports, but the majority of those funds are being used to cover the cost of supports at home, make sure your client knows this can affect supports they can claim to participate in social and community activities (like joining clubs, volunteering, attending events or taking classes). This can prevent a surprise for them, or a disagreement down the track

Flag additional charges and how they can impact support hours

Transport charges can quickly add up, so if you’re planning an activity where you’re claiming transport and it’s a longer commute than usual, be sure your client understands this will reduce their total support hours, and that they’re involved in that decision. Explain the time and cost of transport to them.

The NDIA has clear rules about claiming for travel, and your client needs to agree in advance before you can charge for it. Our roadmap to NDIS travel and transport tells you everything you need to know about claiming travel in the NDIS.

Providers are expected to publish their prices and provide an explanation for how their fees are billed, which is usually included in a service agreement that both you and your client sign. Good providers will take the extra time to properly explain their fees and gain their client’s consent before extras like transport are charged.

Be vigilant about compliance

At My Plan Manager, we check claims against the Australian Taxation Office’s minimum invoicing requirements, the NDIA’s rules around compliance, and the NDIS Pricing Arrangements and Price Limits. We also review them against our clients’ individual NDIS plans, which have their own set of rules about what can be claimed.

As an NDIS provider, it’s important you have a good understanding of compliance yourself before booking a client in. Make sure the items or services you provide are something the NDIS actually covers (check that they’re they’re approved NDIS supports), because if they’re not, you might run into issues later and that can delay your payment or stop it altogether.

Claiming in the NDIS can be tricky but you’re not alone. If you have a question about a claim, we’re here to assist. You can email us at enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday.

What we check before an NDIS invoice gets paid – and why it matters

Managing claims and paying providers is a big part of what we do at My Plan Manager. We check the invoices that are sent to us, and if everything on them looks correct, we submit them to the National Disability Insurance Agency (NDIA). Then, once they’ve been approved and the NDIA has sent us the funds, we pay the invoices.

Claims in, money out. Simple, right?

Well, there’s a bit more to it. In fact, we go through quite a big checklist to make sure your claims are paid quickly and correctly, so you and your providers aren’t left hanging.

With the NDIA cracking down on fraud and non-compliance in the National Disability Insurance Scheme (NDIS), every claim is scrutinised. That’s why we scan each invoice with a fine-toothed comb to check it meets the Agency’s requirements before we send it their way.

Our anti-fraud technology is the best in the market, so when you submit an invoice to us, we run more than 30 automated checks on it to make sure it ticks all the NDIA’s boxes. If a claim doesn’t look quite right, our team will work with you and your providers to make sure it's correct before we submit it to the Agency.

To help you understand exactly what we look for – and why we sometimes ask you questions about the invoices you send us – here are the key checks we run to make sure your claims can be processed and paid as quickly as possible.

1. We check that invoices meet Australian Taxation Office requirements

The Australian Taxation Office’s minimum invoicing standards require tax invoices to include key information, like an Australian Business Number and a clear description of the goods or services provided.

This page on the NDIS website explains everything providers need to include on NDIS invoices and the records they have to keep.

Our article about payment integrity audits is also a useful resource for NDIS providers and their clients.

2. We check claims against the NDIS support lists

The NDIS support lists outline which services and supports can and can’t be funded by the Scheme.

Introduced in late 2024, the lists help everyone better understand what could possibly be funded through an NDIS plan. The rules also outline how people can request replacement supports in specific circumstances.

Before we process an invoice, we double-check it against the official list of NDIS supports. This helps make sure the support is something that's generally approved and is unlikely to be flagged as a concern by the NDIA.

3. We check claims against the NDIS Pricing Arrangements and Price Limits

The NDIS Pricing Arrangements and Price Limits (formerly known as the NDIS Price Guide) includes a support catalogue that outlines all the supports funded by the NDIA, as well as the maximum prices providers can charge for them.

In addition to price caps, the document includes helpful information like:

We check all these pricing rules against your invoice, because if they're not followed, the NDIA will send your claim straight back to us.

To simplify the NDIS Pricing Arrangements and Price Limits – a very complex document – and give a bit more information about how we check your claims, we’ve created this explainer.

4. We check claims against your NDIS plan

Every NDIS plan is different, which means your funding might work a little differently from someone else’s. How it’s set up and which support categories it includes, determines what you can use it for.

There are specific rules we need to follow when claiming payments, and those rules are based on how your plan is structured. Your plan could include things like stated supports, flexible supports, quoting requirements, and more… and, well, it can all get a bit complicated!

We recommend you work together with your providers to make sure they understand what’s funded in your plan. There’s nothing worse than starting a new service or placing an order, only to find your plan can’t actually cover it. This is where service agreements are a great idea to make sure everyone’s on the same page.

When we may ask for more information

There are times when we may request more information about a claim before we can process it. For example, where a support isn’t aligned with the funding in your plan, a letter of recommendation will likely be required by the NDIA. If the support is high-risk or complex, the Agency will usually want to see evidence that it’s safe to use, which can be provided in a letter of recommendation.

Sometimes it may be considered sufficient evidence if an allied health professional submits a high-risk assistive technology claim themselves – like a podiatrist claiming orthotics – because then it means the support is likely to be used safely. But it’s always best to check with us first.

Once a claim is submitted to the NDIA

When a claim is sent off to the NDIA, it’s put through the Agency’s many checks and scrutinised for compliance. Hopefully, all our checks mean it will quickly be given the tick of approval, and the funds will be released from your plan, so we can pay your provider.

If a claim is found to be not compliant, the NDIA will let us know, and we'll pass that information along to you.

Sometimes the Agency might tell us an invoice needs to be amended, and if that’s the case, we’ll touch base with you and your provider to make any changes that are needed, and then we’ll resubmit the invoice for payment.

Other times, the NDIA might request more information about a claim, like additional evidence that the support fits your needs. Again, we’ll let you know straight away so you can gather the information you need.

While waiting, the NDIA will keep the claim on hold – but once the right information is submitted and the claim is validated, it’ll be added to the Agency’s next payment run. The NDIA will notify us when to expect the funds, and we’ll let you know.

We’re here to help

If you have a question about claiming in the NDIS, we’re here to assist. You can email us at enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday.