New NDIS Claim Review Process - March 2024

Please see below new Claims Review Process as advised by NDIS

We are taking some steps to strengthen the NDIS, by reducing fraud and non-compliant behaviour.

This means from March 2024, we may take more time to check some claims before they are paid.

Valid claims will be paid within 2 to 3 business days. Some payments may take up to 10 days.

Claims review process:

Duplicate claims submitted within 14 days of the first claim will be reviewed for fraud and non-compliant behaviour. If invoicing via a Plan Manager and a duplicate invoice is submitted within 14 days this will also be reviewed for fraud and non-compliant behaviour.

If a payment within a bulk claim is being reviewed, only the claim under review will be held. All other claims will be paid according to NDIA payment terms.

If a claim is being reviewed, we will send you:

a request for information
a fact sheet with instructions on how to resolve the specific claiming issue.

When we receive the right information, we will add the claim to the next payment run.

If the information is not satisfactory (or if we receive no response), the claim will stay on hold. It will not be paid until we receive the right information.

Consider reviewing all your claiming and invoicing systems and processes to ensure they align with our payment terms and won’t hold up any payments.

For more information about NDIA provider payment terms, please visit the NDIS website.

For Plan Managers

It is important for plan managers to be aware the invoices could be flagged for review after a successful remittance. We are still working with NDIS to add indicators to identify these. For now these on hold claims will need to be manually flagged in the system to ensure it is not included in the ABA.

This can be done by clicking the following button on the batch:

Then scroll to the very bottom and click the Old Version link.

Invoices statuses should be set to Rejected to clear any recorded payment and then to any appropriate status of your choosing - following these steps will not cancel the claim in PRODA, only update the status within Brevity. It is important not to unlock the invoice or cancel the claim while under review by NDIS.