We know swift payment is vital to you.
Itโs not compulsory, but when you submit an invoice to a plan manager or the National Disability Insurance Agency (NDIA), including the right line item code can push the claim through faster. But more importantly, the NDIA has rules and requirements around line items that, if not adhered to, could cause an invoice to be declined.
In this article, we unpack and simplify line items and explore why claims get rejected, to help you pre-empt and avoid common roadblocks. This is a must-read resource for providers.
The National Disability Insurance Scheme (NDIS) Pricing Arrangements and Price Limits contains more than 800 line items for providers to claim from!
And, given a line item lets the NDIA know which budget category in your clientโs plan should pay for your services, they're one of the most valuable tools in a provider's toolkit.
To simplify line items, letโs break them down.
A line item has two components: a numerical code (โItem Numberโ) and a description of the service provided (โItem Name and Notesโ). Below is an example from the NDIS Pricing Arrangements and Price Limits.
Each Item Number contains a support category, sequence number, registration group, outcome domain, and support purpose. When broken up, it looks like this:
When youโre locating a line item in the NDIS Pricing Arrangements and Price Limits, it helps to understand โsupport purposesโ and โcategoriesโ.
NDIS funding is broken up into four support purposes or โbudgetsโ โ Core Supports, Capital Supports, Capacity Building Supports and Recurring Supports. We explain whatโs included in each of these budgets here.
Within each budget, there are several categories โ currently there are 21 under the NDIAโs new PACE computer system. You can find out more about PACE here.
Take a look at the budget and category breakdown below:
To find the correct line item, open the NDIS Pricing Arrangements and Price Limits, find the
correct budget (i.e. Core Supports, Capital Supports or Capacity Building Supports) and category,
(i.e. 01 Assistance with Daily Life), then locate the line item that aligns to the service youโve provided. You can identify this through the โItem Name and Notesโ seen in the example below:
The NDIA has rules and requirements around line item codes that, if not adhered to, could cause a claim to be declined.
At My Plan Manager, we see thousands of invoices every week and can tell you from experience what the NDIA does and doesnโt accept.
To help you pre-empt and avoid roadblocks, weโve outlined a few common causes of claim rejections.
For example, if you invoice for personal training when your client doesnโt have the Improved Health and Wellbeing category in their NDIS plan, the claim will be rejected.
As a provider, youโre reliant on your client to be transparent about their NDIS funding, so you know itโll cover the supports you provide. Thatโs why itโs good to understand whether your supports are funded, and to put a service agreement in place. Both reduce the likelihood of a claim being denied.
Here are our tips for writing an A+ service agreement.
Takeaway: Before commencing supports, check with your client to make sure there's funding available in their plan for the budgets and categories related to your services โ and make sure thereโs enough funding left to cover your fees.
In the NDIS, therapeutic supports are delivered by a broad range of qualified professionals. They also account for one of the largest groups of funded supports in the Scheme.
Many therapeutic supports are delivered by allied health professionals (e.g., an occupational therapist) โ university qualified professionals with specialised expertise in developing and implementing strategies to help build a participantโs capacity for independence.
Therapeutic supports can be delivered by a range of professionals, if their qualifications align with the NDIS Pricing Arrangements and Price Limits. For example, a qualified music therapist whoโs registered with the Australian Music Therapy Association can deliver therapeutic supports to NDIS participants.
Takeaway: If youโre providing therapeutic supports to an NDIS participant and charging as an allied health professional, youโre required to have the correct credentials to provide the therapies the NDIA recognises. Generally, alternative therapies arenโt funded under an NDIS plan, and established therapies are much more likely to be funded. But, if an alternative support meets the NDIAโs reasonable and necessary criteria, it may qualify and be covered.
The NDIA requires providers to claim within the rates set out in the NDIS Pricing Arrangements and Price Limits. If a claim exceeds those rates, it indicates a provider is either using the wrong line item or charging above the approved rate. Below are two examples:
Takeaway: Be sure your claim doesnโt exceed the NDIS Pricing Arrangements and Price Limits, and if it does, check it contains the right line item code.
The NDIS Pricing Arrangements and Price Limits is continually changing and sometimes providers submit claims with line item codes that no longer exist.
For example, from 1 January 2024, providers will need to claim for group-based supports under new pricing arrangements from the NDIA. If providers claim under the old method after this time, their claim will be declined, and theyโll need to resubmit it using the new pricing arrangements.
Takeaway: Be sure the line item code youโre claiming against is current.
The NDIA has other claiming rules that providers are expected to adhere to as well. Hereโs just a few:
If you need help or a second opinion about line items or claims, weโre here to help. 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.
Updated 14 February 2025