NDIA Accountability Project

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Self-Managed Payments

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MR25/02131 | FOI 25/26-0515 DOCUMENT 4

Self-Managed Payments Payments Triage Capability Hub

Exported on 2025-11-06 08:37:56

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Payments Triage Capability Hub – Self-Managed Payments

Table of Contents

1 Self-Managed Payment Pre-requisites ……………………………………………………………………. 4

2 Related procedures or resources …………………………………………………………………………… 5

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Payments Triage Capability Hub — Self-Managed Payments

This article provides guidance for Payments Triage Officers to:

e understand the pre-requisites to progress a Self-Managed Payments related Claim and Payment Enquiry

Recent updates Date What’s changed October 2024 Self-Management Claim form updates.

Topic Checklist

Pre- e Received a Claim and Payment Enquiry related to Self-Managed requisites Supports.

Actions Steps or Sections:

e Self-Managed Payment Pre-requisites

Additional Information

e Related procedures or resources

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Payments Triage Capability Hub – Self-Managed Payments

1 Self-Managed Payment Pre-requisites

Only Self-Managed Payment Enquiries that include a completed MSC Form which is signed or submitted by the Participant, Plan Nominee, Payment Nominee or Child Representative can be processed. Refer to Invoice and Manual Claim Form Requirements for more information.

To qualify for the Manual Self-Management Claim (MSC) Process, the requested payment and MSC Form must:

• Be for Self-Managed supports included in the Participant’s plan;

Note: Under limited circumstances, where there has been a planning error or funds management issue identified, a manual payment for supports may be facilitated to the Participant on the impacted plan where the supports are Agency-Managed.

BAU MSC requirements and Invoices are required for these circumstances.

• Not be for an amount that will exceed the Participant’s budget;

Note: Partial Payments can be processed up to the value remaining in the Participant’s budget (Current Plan).

Where the request relates to a previous plan or claim coverage and request amount will exceed the remaining Budget amount, compliant invoices will be required as supporting documentation with the compliant MSC Form.

• Where the supports are for multiple plans, clearly set out which supports were purchased in each plan period on the MSC form.

Note: One MSC form may be completed for multiple plan periods providing the supports are clearly split according to the correct plan date periods

Where a Requested Payment meets the criteria for the MSC Process, the Payment Enquiry will be triaged to the Claims and Payments Enquiry Routing Queue.

Payments Triage Officers will refer the CPE to the Payments Team following the process outlined in the Internal Referral to Payments Team Resolution Process.

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Payments Triage Capability Hub – Self-Managed Payments

2 Related procedures or resources

• Invoice and Manual Claim Form Requirements • Internal Referral to Payments Team Resolution Process

Document Owner and Approver

Director Service Delivery Enablement

Feedback

To submit feedback to the Payments Team visit the Scheme Claims and Payments Feedback page. The Capability Team is responsible for managing all feedback on our guidance articles.

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OFFICIAL - Payments Capability Hub

ndis

Self-Managed Payments

This article provides guidance to payments officers to understand the requirements when reviewing claim and payment enquiries for self-managed supports.

Recent updates

Date What’s changed

November @ Updated requirements for reviewing self-managed supports to include duplicate check

2024 procedure for CRM plans and referral to CRM Plan S7S@)5e=t=iiepertensotasenees /Over Budget SOPs.

Topic Checklist

Pre- @ Received a completed Manual Self-Managed Claim Form.

requisites

e@ = There is sufficient funding available to process the manual claim.

@ Enquiry relates to funded supports purchased or provided to the participant prior to the 3rd of October 2024.

@ Enquiry relates to supports purchased or provided to the participant on or after the 3rd of October 2024 are on the ’In List’.

@ CPEs with a “Received Date” on or after 1 November 2024 must include attached invoices/evidence and provide an ABN or a reason for exclusion.

Action Sections:

e@ Understand the Requirements for Reviewing Self-Managed Supports

e Self-Managed Procedure

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Payments Capability Hub Self-Managed Payments

Topic Checklist Additional Information

@ Related procedures or resources

Understand the requirements for reviewing self-managed supports

  1. The participant or authorised representative managing the funded supports must have submitted a completed self-managed manual claim form (Manual Self-Managed Claim Form) with all the all relevant details.

  2. There can only be one authorised representative managing the funded supports.

  3. If a self-managed manual claim form has been submitted by an authorised representative who is the plan nominee or child representative in PACE, the form can be processed even if they are not yet appointed to manage the participant’s plan funding. However, an internal referral must be made to Service Delivery to appoint an authorised representative to manage the participant’s plan funding for future claims. Refer to Service Delivery - Internal Staff Referral and Service Delivery - Internal Referral Templates.

  4. If the form is not submitted by the participant, ensure the person that submitted it is an authorised representative in the participant’s Person account. The funded support must be self-managed.

  5. Providers cannot enquire about self-managed funding or payments and must be advised to contact the participant or authorised representative.

  6. The payment must not have already been paid or have an awaiting approval status. For PACE plans, refer to Review Claim History PACE - Claim Line Items List User Guide to check for duplicate payments in PACE. For CRM

plans, refer to Checking for Duplicate Payments Help Card to check for duplicate payments in SAP-PSCD.

  1. There must be sufficient funding remaining to process the manual claim. If not, consider if payment meets the requirements under PACE Payment Threshold or PACE Over Budget Threshold - Manual Payment Process for PACE plans, or S75@)mcettainopertionsoragences Vianual Payments SOP CRM or Over Budget CRM Manual PSCD Payments for CRM plans.

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  1. Claims with support dates on or after 3 October 2024 must be a NDIS support. Refer to NDIS Supports Section 10.

  2. CPEs with a “Received Date” on or after 1 November 2024 must include attached invoices/evidence and provide an ABN or a reason for exclusion.

The list of NDIS supports is available on What does NDIS fund? and is part ofa transitional rule about NDIS Supports, remaining in place until the Commonwealth and States and Territories formally agree on a new rule to replace it.

Manual Claims Before processing any manual claims, payments staff must first check the date that the support was provided. If the support was provided on or after 3 October 2024 payments staff must review the “Supports that are NDIS supports” list (in-list) available on the What does NDIS fund? webpage, to confirm the claim is for an NDIS support. Where a support is not on the “in-list”, payments officers will not be able to proceed with the manual payment unless:

e@ There is evidence that the support is a replacement NDIS support which has been approved; or

e@ Participant has been funded for the support in their plan prior to 3 October 2024 and evidence exists to support payment. For more information:

@ Payments triage officers can refer to Section 10 - NDIS Supports and Exceptions.

@ Payments officers can refer to NDIS Supports Manual Claim Exceptions.

Update: As of 06/05/2024, self-managed supports can be claimed via the my NDIS app for the most recently expired SAP CRM plans up to 90 days after the plan has ended.

Self-Managed Procedure

  1. Check the Plan nominee and Child representative has been correctly established for the PACE plan. Refer to the steps below to identify the plan nominee or child representative in PACE:

o Inthe participant’s Person account select the Relationships tab.

o Select Authorised reps tab to view the authorised person listed under Roles & Relationships.

o To view the full list of authorities, select the Check Authorities hyperlink.

Click here to view images

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Figure 1 Authorised Reps

  1. If the participant is under 18, they must have a child representative appointed with authority to manage their plan funding. Note: Participant’s under the age of 18 cannot sign a Manual Self-Managed Claim Form and an authorised child representative must sign the form instead.

  2. If a plan nominee or child representative has authority to manage the plan funding, the bank account details are recorded on the authorised representative’s Person account. To locate the information in PACE, refer to the knowledge article Participant and Nominee Bank Accounts.

  3. If the participant signed the form and if there’s no requirement to establish a child representative or plan nominee relationship, you may progress the claim and payment enquiry.

  4. If a plan nominee is authorised to manage the plan funding and the participant signs the form, you can proceed.

  5. Refer to Invoice and Manual Self-Managed Claim Form Requirements for details on requirements for payment. No signature: If the form is received without a signature, the enquiry can still proceed if the form was received from a registered email address for the plan nominee, child representative or participant.

  6. Plan nominee or child representative: If a plan nominee or child representative has signed the form, however they do not have an authority to manage plan funding, you should complete a Service Delivery - Internal Staff Referral using the appropriate Service Delivery - Internal Referral Template.

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  1. If the conflict of interest is recorded against an authorised representative, speak to your Team Leader before resolving the claim and payment enquiry

• To view Conflict of interest, follow steps listed on point 1.

• If there has been a Conflict of interest recorded against an authorised representative, Conflict of interest box must be ticked, and the name will be recorded under Conflict of interest details.

Note: If the authority to manage plan funding has not been established, you can still proceed with completing the review of the claim and payment enquiry. Check existing internal notes and identify if a case has previously been assigned to Service Delivery requesting an authorised representative be appointed to managed plan funding and where applicable, check the status of the existing request. Where existing cases are identified, consideration should be made as to whether it is appropriate to progress further forms until the authority to manage plan funding has been determined.

Next Steps

• Review the claim and payment enquiry

• Review the budget

Related procedures or resources

• Invoice and Manual Claim Form Requirements

• Review Claim History PACE - Claim Line Items List User Guide

• Checking for Duplicate Payments Help Card

• Service Delivery - Internal Staff Referral

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• Service Delivery - Internal Referral Templates

• Participant and Nominee Bank Accounts

• PACE Payment Threshold

• PACE Over Budget Threshold - Manual Payment Process

• s47E(d) - certain operations of agencies Manual Payments SOP CRM

• Over Budget CRM Manual PSCD Payments

Document Owner and Approver

Director Service Delivery Enablement

Feedback

To submit feedback to the Payments Team visit the Scheme Claims and Payments Feedback page. The Capability Team is responsible for managing all feedback on our guidance articles.

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