How to Claim NDIS Payment from Each Type of Participant?

Understanding the correct NDIS claiming process for each type of participant can ensure that your organisation are paid on time and efficiently. Here's how to claim NDIS payments for each type of participant.

Self-managed Participants

For self-managed participants, the service provider sends an NDIS invoice directly to the participant or their nominee. Once the participant receives the invoice, they have two options to pay service providers.

For the first option, the participant pays the service provider directly upon receiving the NDIS invoice. Then, they can submit a reimbursement request to the NDIA through the myplace participant portal. Once the claim is approved, the NDIA reimburses the participant directly into their bank account. 

For the second option, participants may choose to request NDIS payments from the NDIA before paying the service provider. The NDIA processes these requests usually within 24 to 48 hours and deposits the funds directly into the participant’s nominated bank account. Then, the participant uses these funds to pay the service provider.

Plan-managed Participants

In the case of plan-managed participants, service providers are required to submit their NDIS invoice directly to the plan manager. These invoices need to include a valid ABN, except for providers who are granted an exemption from quoting an ABN. The plan manager is responsible for processing these invoices and claiming the payment from the NDIS on behalf of the participant. 

To claim the payment, plan managers submit the claim through the myplace provider portal, using the details from the provider's invoice. The NDIA then pays the plan manager, who in turn, pays the service provider. 

Providers need to issue accurate and complete invoices to the plan manager to prevent any payment delays.

NDIA-managed Participants

For NDIA-managed (agency-managed) participants, NDIS-registered service providers claim payment directly from the NDIA by submitting a payment request through the myplace provider portal. Providers need to enter the details of the services provided, including dates and costs, complying with the NDIS Price Guide and Support Catalogue. 

The claim is then reviewed by the NDIA. If it is approved, the payment is made directly to the provider's bank account.

We recommend service providers send the statement to notify the participant about the upcoming charge for the provided services before submitting the claim on myplace provider portal.

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NDIS Payments for Group-based Social and Community Participation Support

NDIS Group-based social and community participation focuses on social interactions, learning new skills, and participating in community activities.

In 2023, a new NDIS pricing arrangement for group-based support was introduced. Among all group-based supports, the updates for social and community participation support stand out the most.

• The new pricing arrangement separates charges for Centre Capital Costs and Non-Face-to-Face (NF2F) activities from the direct support rate. 
• Service providers need to claim each cost separately using the new pricing arrangement.

Overall, the old pricing is a maximum rate, per hour, per participant (including NF2F costs and Centre Capital costs). On the other hand, the new pricing arrangement is a maximum rate, per hour, per group (only including direct support).

Group Direct (Face-to-face) Support

Under the new pricing arrangement, splitting the big groups into smaller groups is more beneficial for providers.

The old pricing model is a maximum rate, per hour, per participant. So, the more participants in the group, the higher the potential earnings for the provider. In contrast, the new pricing arrangement is a maximum rate, per hour, per group. That means adding more participants to a group beyond a certain size doesn't increase the revenue. 

This new change encourages the providers to split the big groups into smaller groups. As a result, understanding each participant's needs is important to arrange the groups and allocate resources effectively.

Under the new pricing model, the group's hourly rate is still divided evenly by the number of participants in the group.

1:1 Direct (Face-to-face) Support

When a participant needs 1:1 self-care during group-based support, there's no one-size-fits-all rule. It is a commercial business decision for each provider to charge the participant. 

Providers must consider two factors to make this decision:

• Resource Allocation and Availability: Ensuring participants can receive 1:1 self-care without missing group activities is crucial. For example, if a participant requires 20 minutes for self-care within a 30-minute activity, can they rejoin the group smoothly for an extra 10 minutes? 

• Fair Pricing: Providers must also consider fairness across all participants. If one participant uses 15 minutes for personal care during a 4-hour session, is it fair to bill other participants for 3 hours and 45 minutes?

Clear communication with participants about the billing method is important. You should ensure transparency, prioritise participants' interests, and keep detailed records to justify the support provided and the associated charges.

Non-face-to-face Support.

Non-face-to-face (NF2F) support refers to the activity that does not occur in a face-to-face setting.

There are two types of NF2F support:

• Disability-Specific Support: These supports ensure the participants can safely and effectively participate in group activities. This could involve modifying activities or materials for specific disabilities. The costs for these personalised supports are billed directly to the benefiting participant.

• Group Support Tasks: These are activities that facilitate the smooth running of group support. For example, preparing specific equipment for activities. The expenses are shared equally among all group participants.

When NDIS providers provide NF2F support, they need to keep proper records for different types of costs.

• Disability-Specific Support: Detailed notes, such as case notes or similar evidence, are required to show exactly what was done for the specific participant.

• Group Support Tasks: Documentation might include an entry in a group roster, indicating the general tasks performed for the benefit of the entire group.

You can visit the NDIS website for complete guidance on documenting NF2F support.

Sometimes, service providers have completed the NF2F tasks to prepare for a session, but the participant cancels the session before it starts. In that situation, providers can still claim for the NF2F activity. 

Providers must make sure their service agreements detail the NF2F costs when direct support is cancelled. This will ensure participants fully understand any potential charges they might incur from cancellations.

Centre Capital Costs

The "Centre" refers to the facility or environment designed for specific support needs that are not typically found in standard community settings. The Centre Capital Costs are additional charges for operating and maintaining this facility. These costs can be claimed per hour, per participant.

Sometimes, the group only use the facility partially during the session. In this case, the providers can still claim for the Centre Capital Costs if the centre remains available for the entire session. 

For example, a group of participants meets 6 hours every Friday in a centre for a group-music session. One day, they decide to attend a free concert nearby, leaving the centre for about 2 hours. Even though a group only spend 4 hours in a centre, it should still be available whenever they need during the 2-hour concert. For instance, if a surprise storm disrupts the concert, the group may need to return to the centre. As a result, service providers can charge for the entire 6 hours.

Besides, the centre must be genuinely available to all participants in a session, even if they are not physically at the centre for the entire time. 

For example, a service provider has a group of 20 participants, but their centre can only accommodate 10 at a time. To manage this, they split the participants into two groups of 10, rotating them in and out of the centre during the session. In this case, the centre is not genuinely available for all 20 participants. Therefore, the provider cannot charge Centre Capital Costs for all 20 participants.

Finally, the Centre Capital Costs cannot be claimed for the temporary hire of community facilities, such as swimming pools. It's because providers do not incur expenses for operating and maintaining these facilities.

Program of Support

A Program of Support (POS) is a structured series of supports and services that are designed to support an NDIS participant to achieve specific goals. Implementing a POS is not mandatory. 

The program of support can be applied across various group-based supports:

• Assistance with Social, Economic, and Community Participation Support Category: This includes group-based support and Supports in Employment.

• Assistance in Shared Living Arrangements - Supported Independent Living: Part of the Assistance with Daily Life Support Category.

• Capacity Building Support Category.

Providers can claim a regular weekly amount for the duration of the POS, which can last up to 6 months. Delivering services through POS helps simplify the billing process and eliminates the need to recalculate costs for each session.

The standard claim for short-notice cancellation doesn't apply to the Programs of Support (POS). However, the providers can only claim for unscheduled absences if the support is prepared and ready to be delivered. If the participant notifies the providers and schedules an absence, the provider needs to adjust the service delivery.

Providers must be upfront about the terms of support to ensure participants understand how absences are treated within a POS. Participants are responsible for informing providers about planned absences or the decision to exit the program.

NDIS Payments for Short-term Accommodation

NDIS Payments for Short-term Accommodation (STA) cover the cost of temporary accommodation and support for participants away from their usual homes. This includes personal care, accommodation, meals, and agreed activities. STA is a great option for participants who need a break or when their usual carers are unavailable.

How Much STA Can Be Funded? 

STA is generally funded at a group rate, meaning participants may share support with others. This is reflected in the staff-to-participant ratios (e.g., 1:2, 1:3, or 1:4) specified in STA line items. If participants need 1:1 support due to their disabilities, exceptions for a 1:1 ratio can be made. 

The STA is funded up to 28 days annually and can be utilised in various ways. For example, up to 14 consecutive days or 2 days every weekend for 28 days per year.

How to Get Funded for STA? 

To get funded for STA, the participants often look for the providers that:

• Have experience in delivering STA services effectively.
• Offer group packages and support that align with the participant's needs and goals.
• Demonstrate how their services provide clear benefits and represent value for money.
• Include all accommodation, food, and necessary support in a package price.

Below are some situations that are not covered by STA.

• Emergency Accommodation: STA does not cover emergency accommodation needs because specialised service is already available for such cases in each State and Territory.
• Medium or Longer-term Stays: Stays extending beyond a consecutive 14 days fall under "Medium Term Accommodation".
• Accommodation Without Supports: Services that only offer accommodation without additional support tailored to the participant's goals may not qualify for STA funding.
• Over-Priced Supports: The NDIS sets specific price limits for each type of STA support. Providers must ensure their services are priced within these limits to qualify for funding.

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NDIS Payments for Short-notice Cancelation or No-Show

Short-notice cancellations or no-shows can significantly impact the financial aspect of your organisation. 

NDIS Guidelines suggest that a provider can claim 100% of the agreed fee if the participant doesn't arrive or requests short-notice cancellation. Please note that this rule is not applied to a program of support.

What is Short-notice Cancellation?

The NDIS defines a short-notice cancellation if the participant:

• Fails to show up for scheduled support within a reasonable time,
• Is not present at the agreed place and within a reasonable time if the provider travels to deliver the support.
• Provides less than seven (7) days' notice for cancelling a support session.

Criteria for Claiming Short-notice Cancellation.

Providers can only claim for short-notice cancellations under a participant’s plan if all the following criteria are met:

• The support item allows claims for short-notice cancellation, according to the NDIS Pricing Arrangements and Price Limits.
• The charges comply with the NDIS Pricing Arrangements and Price Limits.
• The service agreement outlines that short-notice cancellations can be claimed.
• The provider could not find alternative billable work and must compensate the worker for the scheduled time.

Group Support Cancellations

For group-based support, if a provider faces a short-notice cancellation without finding a replacement participant:

• The provider can charge the short-notice cancelling participant at the agreed rate.
• Other group participants are billed as if all participants attended.

Claiming Process for Short Notice Cancellations

• Step 1: Claim using the same support item as would have been delivered.
• Step 2: In the NDIS myplace portal, select the “Cancellation” option for the claim, indicating it is for cancellation and claim the full agreed price.

Note: If the service agreement with the participant includes a specific cancellation clause, it supersedes NDIA rules on cancellations.

Limit on Cancellations

There is no set limit on the number of short-notice cancellations a provider can claim. However, providers are expected to monitor if the number of cancellations is unusual, as it may indicate underlying issues. The NDIA monitors cancellation claims and may reach out to providers with high cancellation rates for specific participants.

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NDIS Payments for NDIS Activity-based Transport.

In this section, we'll provide a quick overview of NDIS Activity-based Transport and explain how to make claims for it.

What is NDIS Activity Based Transport?

The Activity Based Transport is defined as a transportation service needed for community participation support. 

If the Service Agreement includes your transport service and the participant agrees, you can claim for the support worker’s transportation time and related non-labour costs.

If you are under the Assistance with Social, Economic and Community Participation and Capacity Building support categories, you can provide transport services upon a participant's request.

The claimable Capacity Building support categories include:

• Finding and keeping a job
• Improved learning
• Improved living arrangements
• Increased social and community participation
• Support Coordination
• Increased social and community participation
• Improved relationships

How to Claim for NDIS Activity-based Transport?

1. Worker Time

When claiming for workers' time, you can bill for the total time spent in supporting the participant, including accompanying and actual transport times. This amount is calculated at the agreed hourly rate for the primary support. You should claim this cost through the appropriate Community Participation or Capacity Building support items. 

For example: A support worker transports a participant to and from a community activity, and the total time for travel and activity engagement is 2 hours, then the provider can claim these 2 hours at the agreed-upon rate.

2. Activity-based Transport 

You can also claim for additional transport-related costs such as road tolls, parking fees, and vehicle running costs. 

You can negotiate with participants to make reasonable contributions based on specific rates for different vehicle types and other transport costs:

• Up to $0.97 per kilometre for a vehicle that is not modified for accessibility.
• Up to $2.76 per kilometre for a vehicle that is modified for accessibility or a bus.
• Up to the full cost for other transport or additional expenses like tolls, parking, and public transport fares.

When transporting multiple participants together, these costs should be equitably divided based on prior agreements with each participant.

Example: Claiming for NDIS Activity-based Transport

You support a participant's swimming pool trip, below is the summary of your support:

• Transporting the participant to the pool takes 25 minutes.
• Providing support at the tool for 40 minutes.
• Transporting the participant back home takes 20 minutes.
• The agreed hourly rate is $92.12, covering transport and activity support.
• The pool is 10km away from your client's home.
• Additional costs include a $4.50 parking fee and $0.85 per km for running expenses, totalling 20km.

Below is the breakdown of your claims in three parts:

• Total transporting (to the pool and back to home) plus support cost at the pool: (45/60 * $92.12) + (40/60 * $92.12) = $130.50. This is the primary support. (04_104_0125_6_1).
• Additional vehicle expenses (20km): (2*10)*$0.85 = $17 as Activity Based Transport (Kilometres) (04_590_0125_6_1).
• $4.50 for parking as Activity Based Transport (Parking) (04_590_0125_6_1)

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NDIS Payments for NDIS Provider Travel?

In this section, we'll provide a quick overview of NDIS Provider Travel and explain how to make claims for it.

What is NDIS Provider Travel?

NDIS Provider Travel is designed to cover the costs and time for support workers travelling to participants for face-to-face support. It includes journeys to the participant's home and potentially back to the provider’s office. To claim Provider Travel, several conditions must be met:

1. The NDIS Pricing Arrangements and Price Limits indicate that you can claim for Provider Travel related to that support item.
2. The travel charges must comply with the NDIS Pricing Arrangements and Price Limits.
3. The travel must be a part of delivering a specific disability support item to that participant.
4. The support must be delivered directly, through face-to-face interaction.
5. Service providers must explain to the participant why paying for provider travel is a good use of their NDIS funds.
6. Service providers must have the participant's advance agreement, which should specify the travel costs that can be claimed.
7. Service providers must pay the worker delivering the support for the time they spent travelling unless they are sole traders travelling from the usual place of work to or from the participant, or between participants.

The NDIS allows for travel claims in two types:

• Labour Costs: the time and effort of support workers 
• Non-Labour Costs:  kilometre cost, parking fees and road tolls

How to Claim for NDIS Provider Travel?

NDIS Provider Travel - Labour Costs (Travel Time)

Provider Travel - Labour Cost covers the time support workers spend travelling with the participants. This cost must be claimed separately from primary support services. 

The amount you can claim for this travel time depends on the Modified Monash Model (MMM). The MMM model ranks areas as regional, remote, or very remote based on their population density.

Providers need to check the NDIA's detailed list to determine their area's classification accurately. This is important because the claimable amount for travel-related labour costs can differ greatly based on the area's classification. 

Below are essential factors to keep in mind while preparing your claim:

• You can claim up to 30 minutes (MMM1,2,3 areas) or 60 minutes (MMM4,5 areas) for travelling to each participant.
• If you’re delivering core and capacity-building supports and you must pay your worker for this return travel time (as part of the employment agreement), you can claim up to 30 minutes (MMM1,2,3 areas) or 60 minutes (MMM4,5 areas) for the return journey from the last participant to your usual workplace.
• If a worker serves multiple participants in a 'region’, you can distribute the travel time (including the return journey, where applicable) among these participants, with prior agreement from the participants. 
• Submit travel claims separately from the primary support claim using the same line item and the "Provider Travel" option in the Myplace portal.
• Calculate the claimable travel costs using the agreed hourly rate for the primary support (or a lower hourly rate) with prior agreement from the participant. 

NDIS Provider Travel - Non-labour Costs

For NDIS Provider Travel non-labour expenses, such as road tolls, parking, and vehicle running costs, service providers can discuss these with participants to make reasonable contributions. The reasonable contributions are:

• Up to the full amount for other transportation-related costs like road tolls, parking, and public transport fares.
• Up to $0.97 per kilometre for provider or worker-owned vehicles.

When you travel to multiple participants in a single journey, you must distribute the non-labour costs among the participants, according to the prior agreement.

You can only claim for this cost as part of Provider Travel related to a support item if it is allowed by NDIS.

Additionally, you must claim this cost separately from the primary support services and travel time under the specific support item "Provider Travel - non-labour costs," as outlined in the NDIS Pricing Arrangements and Price Limits.

Example: Claiming for NDIS Provider Travel.

You support a participant in Zone 3 of the Modified Monash Mode to provide 2 hours of Core support (Assistance With Self-Care Activities). below is the summary of your support:

• Travelling 30 minutes (20 km) to help a participant.
• The agreed hourly rate for the Core support is $72.13.
• The agreed rate for vehicle running costs (non-labour costs) related to the travel is $0.85 per kilometre.
• The toll fee is $10.

Below is the breakdown of your claims in three parts:

In Zone 3, the travel claim is capped at 30 minutes, meaning the maximum travel time you can claim is 30 minutes.

• Two hours of Core support: $72.13 * 2 = $144.26 (01_015_0107_1_1, no longer 01_301_0104_1_1)
• 30-minute travel time to the participant: (30/60) * $72.13 = $36.07 as Provider Travel (Labour cost) (01_015_0107_1_1)
• Vehicle running costs: $0.85 * 20 = $17 as Provider Travel (Kilometres) (01_799_0107_1_1)

The toll fee: $10.00 as Provider Travel (Toll charges) (01_799_0107_1_1)

How Long Do NDIS Payments Take?

The NDIS payment processing time depends on the type of participant. Here's an overview of how long NDIS payments typically take for each fund management option:

Self-managed Participants

For self-managed participants, the speed at which providers receive payment depends on how the participant chooses to make the payment.

Option one is that the participant chooses to pay the provider before requesting reimbursement from the NDIA. Then, the speed of payment depends on how quickly the participant pays the provider after receiving the invoice.

Option two is that the participant chooses to request reimbursement from NDIA before paying the service providers. It usually takes 24 to 48 hours for the NDIA to process and transfer the funds to the participant's bank account. Then, it will depend on how quickly the participant makes the payment after receiving the reimbursement.

Plan-managed Participants

For plan-managed participants, the processing time depends on the plan manager's internal processes. Upon receiving the NDIS invoice, plan managers have 5 business days to review and validate the invoice details, and then submit a payment request to the NDIA.

Once the plan manager submits the payment requests, the NDIA usually processes these payments within 2 business days. The plan manager will then make the payment to the service provider, which can add additional time depending on their payment cycles and processing times.

NDIA-managed Participants

Service providers must submit their payment requests through the myplace provider portal within 90 days from the end of the service booking.

The NDIA typically processes these payment requests within 2 to 5 business days. Once processed, the payment is directly deposited into the service provider's bank account. The processing time depends on the provider's bank, but generally, payments are received shortly after they are processed by the NDIA.

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Dealing with NDIS Payment Disputes

Dealing with disputes and reconciliations is an important part of managing NDIS payments and invoices. Service providers need to have a clear and efficient process to address any disagreements that may arise. Here’s how providers can effectively manage these situations:

Understanding the Basis of Disputes

Disputes or complaints can occur for various reasons, including disagreements over the services provided, the amount invoiced, the quality of service, or errors in the NDIS payment process. Identifying the root cause of the dispute is the first step towards resolution. It’s crucial to listen to the participant's or plan manager's concerns and review all related documentation, such as service agreements, invoices, and progress notes,... 

Effective Communication

Open and clear communication with the participant, their family, or the plan manager is crucial. Sometimes, disputes come from misunderstandings. In this case, you can provide explanations and documents, such as service agreements, timesheets, service logs, or progress notes to help clarify any misunderstanding. This approach also demonstrates your commitment to delivering quality services to the clients.

Utilising the NDIS Portal for Reconciliation

The NDIS myplace portal is a valuable tool for reconciliation processes. Your team can use the portal to review payment history, and track submitted claims. You can spot any payment inconsistencies or errors by regularly reviewing account statements and payment records. This process is crucial for quick dispute resolution.

Work with Plan Managers or the NDIA

For plan-managed participants, the plan manager can help resolve disputes. They can provide additional insights into the participant's plan, budget allocations, and the specific details of claimed services. 

In cases where resolution is challenging, reaching out to the NDIA for guidance and support can be beneficial. The NDIA can offer dispute resolution services and clarify policy-related questions that might be helpful.

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Why Your NDIS Payment Requests Are Rejected?

Service providers sometimes face many challenges in the payment process. In this section, we discuss the common mistakes that make your NDIS payment requests rejected and the solutions to ensure a hassle-free payment process.

Exceeding NDIS Price Limits

The NDIS Price Guide specifies price limits for each service to ensure fairness and sustainability. If you support plan-managed and NDIA-managed participants, invoicing for services at rates above the price limits is a common mistake that leads to rejected NDIS payments.

If your organisation handle invoices manually, you must regularly review the Support Catalogue to ensure the correct price limits. Alternatively, you can consider using Comm.care for a more streamlined process. Comm.care ensures your invoices are not only compliant but also accurately updated with the most recent price limits. 

Incorrect Funding Categories or Item Codes

Using incorrect categories and item codes often results in the NDIS payments rejection. This is because these codes can vary according to the day or time that services were provided.

To avoid this, you should carefully check the Support Catalogue for the correct item codes and categories relevant to the services. Alternatively, you can use Comm.care to automate this process. For example, NDIS line item codes and prices are pre-populated from progress notes to generate NDIS invoices.   

Incorrect Dates of Service

Incorrectly including service dates for each support provided can lead to rejected NDIS payments. 

Every single time you provide a service, you must list it on a new line with the corresponding date. Ideally, you should add the time because price limits often vary between daytime and evening services.

The time recording process can be complicated. With Comm.care, you can accurately record the date of service delivery, billable and non-billable hours, and transport distances and times. As a result, you can prevent rejected NDIS payments and streamline the entire invoicing process.

Surpassing a Client’s Funds

Billing more than the participant's allocated budget can result in the NDIS invoice rejection. On the other hand, not fully utilising a client’s funds will make the client miss out on entitled services, and reduce your income. 

Monitoring a client’s budget closely and forecasting their usage is key to maximising their funds without overspending. For clients with multiple sources of funds, it's crucial to manage these separately to prevent overspending on one service while leaving another one underutilised.

Alternatively, you can utilise Comm.care's roadmap feature to track service delivery, budget allocation, and utilisation rate. As a result, you can adapt care plans based on the data and ensure that your clients’ needs are met without exceeding their funds.

Not Claiming NDIS Payments in Bulk

In scenarios where your organisation need to handle many NDIS invoices manually, human errors can occur, leading to rejected NDIS payments. 

Adopting a bulk invoicing approach can help your organisation save time and reduce the likelihood of mistakes. For example, Comm.care enables your team to generate hundreds of compliant NDIS invoices with a few clicks. Once generated, you can send them in bulk to plan managers, upload them to PRODA, or export them directly to accounting systems like Xero, MYOB, or QuickBooks.

This feature not only minimises human errors but also enhances the claiming efficiency. It allows your team to focus more on delivering quality care rather than being overwhelmed by paperwork.

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How to avoid rejected NDIS Payments and get paid faster?

If you find manual invoicing time-consuming, Comm.care can help you save time and reduce the likelihood of errors and disputes. Comm.care allows your team to generate thousands of accurate and compliant NDIS invoices with just 3 clicks.

Besides, Comm.care enables you to export data in the NDIS bulk upload format and import them to the NDIS myplace Provider portal (Proda portal) as NDIS bulk payment requests.

With advanced automation, Comm.care further allows you to

• Have the latest NDIS price guide automatically updated, ensuring invoices reflect current pricing models.
• Match services delivered with clients' care plans, guaranteeing that the correct line items are billed.
• Include multiple line items to the same service provided.
• Create bulk claims and directly upload them to PRODA and/or accounting systems like Xero, MYOB, or QuickBooks.

As a result, you can improve your cash flow and focus on what you are doing best - providing the best care for your clients.