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.
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.
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.
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.
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.
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.
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.
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.
