Review the Documents | FOI document library | NDIA Accountability Project

MR25/02131 | FOI 25/26-0515 DOCUMENT 6

Review the Documents Payments Triage Capability Hub

Exported on 2025-11-06 08:29:16

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Review the Documents ………………………………………………………………………………………….. 5

3 Provider Claim Form ……………………………………………………………………………………………… 6 3.1 Update the Transaction ID on the CPE …………………………………………………………………… 6

4 Related Procedures or Resources …………………………………………………………………………. 7

5 Attaching and Locating Documents ………………………………………………………………………. 8 5.1 Recent updates …………………………………………………………………………………………………… 8 5.2 Locating and downloading documents ……………………………………………………………………. 8 5.3 Attaching supporting documents ………………………………………………………………………….. 10 5.3.1 Document Naming Conventions ……………………………………………………………………………………. 13 5.3.2 Document Type …………………………………………………………………………………………………………… 13 5.4 Link documents to a case ……………………………………………………………………………………. 14 5.5 Related procedures or resources …………………………………………………………………………. 15

6 Invoice and Manual Claim Form Requirements …………………………………………………….. 16 6.1 Recent updates …………………………………………………………………………………………………. 16 6.1.1 NDIS Supports ……………………………………………………………………………………………………………. 16 6.2 Self-Managed ……………………………………………………………………………………………………. 17 6.2.1 Manual Self-managed Claim Form Requirements ……………………………………………………………. 20 6.2.2 Invoice Requirements Self-Managed ……………………………………………………………………………… 22 6.3 Plan and Agency Managed …………………………………………………………………………………. 22 6.3.1 Invoice Requirements Plan and Agency Managed …………………………………………………………… 22 6.3.2 Date/s the support was delivered …………………………………………………………………………………… 23 6.3.3 Activity Based Transport ………………………………………………………………………………………………. 24 6.3.4 Temporary Transformation Payment (TTP) …………………………………………………………………….. 24 6.3.5 Provider Claim Form Requirements ……………………………………………………………………………….. 25 6.4 Related procedures or resources …………………………………………………………………………. 27

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This article provides guidance for payments triage officers to:

• analyse and understand the information/documents provided on the Claim and Payment Enquiry.

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1 Recent updates

Date What’s changed

03 October Section 10 and section 45(5) information removed (added to relevant process 2025 KAs). Provider non-labour transport claiming work-around process removed. Topic Checklist

Pre-requisites e Received a Claim and Payment Enquiry

Actions Steps or Sections:

e Review the documents to determine eligibility to progress the CPE. Additional Information

e Related procedures or resources

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2 Review the Documents

Review the documents attached to the CPE to ensure the related documents are compliant.

• Refer to Invoice and Manual Claim Form Requirements for more information on document compliance.

Analyse the invoices to identify which support category the provider/participant is attempting to claim from.

Payments triage officers can use the NDIS website links below, to confirm the support category.

• Pricing Arrangements (NDIS external website) • Plan Support Budgets (NDIS external website)

If the enquiry was originally submitted as an email to NCC, a general enquiry case would have been created. The NCC will create a CPE where the issue is payment related.

Staff are unable to attach the original email to the CPE, when the NCC create the CPE they will add the general enquiry case number as the parent case to enable staff to view these details.

Refer to Attaching and Locating Documents to understand how to locate and attach documents in PACE.

Note: If a CPE has been created for the incorrect account, it will need to be re-assigned to the correct record and payments staff will be able to progress the enquiry.

Ensure the documents related to the participant or provider account have not been uploaded to the incorrect account. If a document has been incorrectly uploaded to PACE you will need to submit a request to the Privacy Service Desk to delete documents from a participant or provider account, refer to Delete a document from PACE (PACE Knowledge Article).

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3 Provider Claim Form

Providers can submit a Provider Claim Form (PCF) to request manual payment if they are unable to submit a claim electronically. Claiming through the portal remains the preferred channel.

Providers are also encouraged to contact the NDIA if they experience any difficulties lodging their claims online.

Claims submitted using this form will take longer to process than claims submitted through the portal, and evidence must be provided to support each claim.

Payments triage officers will need to identify if the CPE with a Provider Claim Form attached has been submitted by a deregistered provider, registered provider, unregistered provider or a participant (including their authorised representative).

3.1 Update the Transaction ID on the CPE

Provider type Transaction ID Deregistered and registered providers PCF Unregistered providers PCFU

Payment triage officers will then follow the steps outlined in Authorised Representatives and Provider Relationships for process guidance.

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4 Related Procedures or Resources

• Invoice and Manual Claim Form Requirements • Pricing Arrangements (NDIS external website) • Plan Support Budgets (NDIS external website) • What does NDIS fund? • NDIS Supports Exceptions - Triage Procedure • Section 45(5) Payment Review • Attaching and Locating Documents • Privacy Service Desk • Delete a document from PACE

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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5 Attaching and Locating Documents

This article provides guidance for Payments Triage Officers to:

e locate documents within a claim and payment enquiry or under the participant’s person account

e download documents

e attach an Outlook email, email attachments and supporting documents to an enquiry.

5.1 Recent updates

Date What’s changed 12 September 2025 Multiple documents upload note removed. Topic Checklist

Pre-requisites You have received a Claim and Payment Enquiry to review

Actions Sections:

e Locating and downloading documents

e Attaching supporting documents o Document Naming Conventions

o Document Type e Link documents to a case

Additional Information

e Related procedures or resources

5.2 Locating and downloading documents Documents are located within the Claim and Payment Enquiry or within the participant’s Person Account.

e All the documents received or sent are located in the Documents tab in the participant’s Person Account.

e The documents received for the claim and payment enquiry are located within the PACE Claim and Payment Enquiry.

e Select the Documents tab to locate all the documents which have been added to an enquiry.

To view and download all the documents either on the participant’s Person Account or within the Claim and Payment Enquiry follow the below steps:

e Navigate to the Documents tab as outlined above in Step 1.

Click here to view images

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• All documents uploaded to the participant’s record will appear. • Select the tick box under the Document Name. A pop-up box for Document Details will appear.

Click here to view images

• To view the document, select Preview to view the information on the document. • To download the document, select the Download button and open the document from the computer’s download folder.

Click here to view images

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• Once the document is open you can save the downloaded document on your local computer drive. Use the document naming convention table below for naming conventions.

5.3 Attaching supporting documents

Users can attach documents to a claim and payment enquiry case so that payment officers or payments triage officers can efficiently access files related to the enquiry.

Note: Emails from Outlook can be attached to PACE by converting them to PDF, for instructions refer to Add an Outlook email to PACE knowledge article in PACE.

• Within the claim and payment enquiry, select the documents tab

Click here to view images

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• Select add documents

Click here to view images

• The document details screen will display. Complete the fields as guided in the following steps:

o Select supporting information in the document category from the drop-down list

o Select general in the document subcategory from the drop-down list

o Does the document contain any Personal Identifiable Information (PII)? select Yes

o At description use the document type table below for description conventions:

Click here to view images

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•

o If a new version of a document has been uploaded add a version number (e.g. DocType V1, DocType V2).

Note: DocType must be amended to the appropriate document type such as auth form, IAT, MSC, invoice, email.

Information entered here will display on the participant portal. Please ensure it is relevant and respectful.

• Select next • Select upload files from the upload document screen • Select the locally saved document • Select save

o The following may display ‘Upload successful/document uploaded successfully’.

Click here to view images

Note: If a document has been uploaded to an incorrect record/account in PACE or contains information of other participants not relevant to the record/account you will need to report a privacy incident through Privacy Service Desk to delete documents from a participant or provider account, refer to the article Delete a document from PACE.

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Additional files cannot be attached to closed enquiries.

5.3.1 Document Naming Conventions

Click here to view the Document Naming Convention Table…

e Ensure documents are saved locally to your device and named using an appropriate naming convention from the below table. DocName_DateUpdated_$0,000_NDISNumberParticipant_NDISNumberProvider

e For Authorisation Forms, the version numbers must be included for each version of the document that is uploaded to the Claim and Payment Enquiry.

e The $ amount for the Authorisation Form represents the total amount of the manual payment being processed.

5.3.1.1 Document Naming Convention Table: Attachments - Naming Conventions:

DocName_YYYYMMDD_$0,000_NDISNumberParticipant_NDISNumberProvider

AuthorisationForm_YYYYMMDD_V1_$0,000_NDISNumberParticipant_NDISNumberProvide r

AuthorisationForm_YYYYMMDD_V2_$0,000_NDISNumberParticipant_NDISNumberProvide r

Plan Spend Guide_YYYYMMDD_$0,000_ NDISNumberParticipant_NDISNumberProvider

Email_YYYYMMDD_$0,000_ NDISNumberParticipant_NDISNumberProvider

IAT_YYYYMMDD_$0.00_430000000_4050000000

IATO_YYYYMMDD_$0.00_430000000_4050000000

Invoice_YYYYMMDDD_$0,000_ NDISNumberParticipant_NDISNumberProvider

MSC Claim_YYYYMMDD_$0,000_ NDISNumberParticipant

PTP Calculation_YYYYMMDD_$0,000_NDISNumberParticipant

PTP Reversal_YYYYMMDD_$0,000_ NDISNumberParticipant_NDISNumberProvider Important Information & Messages

Internal terminology should not be used in naming conventions. Uploaded Document names are visible to external view and only appropriate terminology should be used.

5.3.2 Document Type

Click here to view the Document Type Table…

e Ensure documents are saved locally to your device and named using an appropriate naming convention selected from the naming convention table.

5.3.2.1 Document Type: Attachments - Description Field:

Auth form V1 Auth form V2

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Attachments - Description Field: Email

IAT

IATO

Invoice

MSC

PCF

PTP reversal

Doc Name (input relevant document name, if not listed above)

Important Information & Messages Internal terminology should not be used in the description field. Uploaded document information is visible to external view and only appropriate terminology should be used.

5.4 Link documents to a case

You can link any document in a person account to a case. You do not have to add another copy of the document. Documents can be linked to multiple cases including claims and payment enquiries (CPE)

e From the case that you are linking the document, select the Documents

e Select Link Documents.

Click here to view images

Case Claim and Payment Enquiry Account Name Type Priority Status Case Number Housing Low New New In Progress Requested further info Details Steps To Resolve Claims Documents Case Activity Add Documents (os | Q Search Document Name File Name Category Sub Category Direction D-10240312 Supporting Information General Inbound |

e On the Link Documents screen, select the checkbox next to the document you want to link.

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• On the Link Document popup screen, select Link. • Select Close. • If you need to link another document, repeat step 3. Otherwise, select Finish. Linked documents will now appear on the Documents tab of the case.

Note: PACE has functionality which allows for documents to be unlinked from a claim and payment enquiry. It is important to remember that all documents pertaining to the claim and payment enquiry such as, invoices, MPP forms, supporting information and authorisation forms should not be unlinked from the case. This includes instances where documents have been updated through the course of resolving the claim and payment enquiry.

5.5 Related procedures or resources

• Add an Outlook email to PACE

• Privacy Service Desk • Delete a document from PACE

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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6 Invoice and Manual Claim Form Requirements

This article provides guidance for payments staff to:

e check what information must be included on an invoice

e understand invoice requirements for self-managed participants

e check manual self-managed claim form requirements.

6.1 Recent updates

Date 12 August 2025

Topic

Pre-requisites

Actions

What’s changed

New provider claim form (PCF) requirements added.

Checklist

e = Participant NDIS number e Provider NDIS number

e Invoices and Manual Self-Managed Claim Form Sections:

e NDIS Supports

e Manual Self-managed Claim Form Requirements e Invoice Requirements Self-Managed

e §=Invoice Requirements Plan and Agency Managed e Date/s the support was delivered

e Activity Based Transport

e Temporary Transformation Payment (TTP

e Provider Claim Form Requirements

Additional Information:

Draft Invoices

Draft invoices are not considered a valid Tax Invoice for the purposes of processing a manual payment. Where it is evident the invoice is a draft and payments staff have determined eligibility for payment consideration, payments triage officers should request a final invoice following the steps outlined in Request Information/Provide Education Internal/External. Payments officers should request a final invoice following

Related procedures or resources

the steps outlined in Request Information Internal/External.

6.1.1 NDIS Supports

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

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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: e Payments triage officers can refer to Section 10 - NDIS Supports and Exceptions. e Payments officers can refer to NDIS Supports Manual Claim Exceptions.

6.2 Self-Managed

Important Notice: Effective from 14 July 2025, an updated manual self-managed claim form has been published.

Enhancements include a new layout of the claim details table. Additionally, new requirements include: e Third-party NDIS number (nominee or representative)

e Payee name (service provider) in claim details table.

Click here to view images…

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[ndis) Participant Claim Form (Self-Managed)

Payoo | payoo’s ABN Support start ‘Support Claim amount ee | or exemption and end date category * (GST inctusive) | feason*

Total claim amount | $

Wcompleiing tha farm electroncally you can inclde addiional rows in the lable above to make eratiple aims

Tris 13 4 form aperoved for the pampases of 8 GA 3 454 of the National Disability Insurance Scherne Act 2013. 1) has of the Napone Disanity Insurance Agency pursuert ’9 5 SAT) of that Act

ndis] Participant Claim Form (Self-Managed) How to complete the table ABN

you do nct have an ABN, please include the reason in the claim table. Reasons may inchide: © “The ABN was not provided in an accessible way.” “L bought this item or NDIS support overseas.” “L bought this item or NOIS support online” © — “Idirectly engage my own staff.“ “The business did not provkie an ABN. Support Category © inthe support category field. write the support category you are claiming. Some examples af a support category are: Consumables: © Improved Daily Living Skits Assistance with sodal, Economic and Community Participation Desenpton of support ¢ Please describe the support or service you are claiming so that ii is clear and meaningful to you. This wif help us understand what support or service was delivered. For example: Physio on 15 Apeil 2024 Assistive Technology (Dragon software) Meal preparation Further advice regarding providing an ABN can be found on the NDIS website (Search ‘Making Claims“)

Thas (9 @ fore 03943 KA Insurance Scheme Act 2013. lt has been acproved by the Cire! Executive Offcer of tne Nationa! Osatdty Inewrance Agency pursuant to 8 9A(T) of that Act

[ndis| Participant Claim Form (Self-Managed)

| declare the information | have provided in each claim to be true and comect. | consent to the NDIS collecting my personal and sensitive information.

Lunderstand that ! may be audited by the NDIS to very the amounts submitted in each claim

° Hacaimis explained, or othenaise of concam, the Agency may seek further information or documentation pursuant to 5 45A(3)\b).

Signature Dato

Dagtal signatures ave acceptable unable to provide a sgnature forms subrted by the parkepant nominee or authansed representative how the emai address registered with us are also accepted

Your privacy and personal information

The NDIA will use the personal information you provide on this form to assist in determining whether your claim is valid and, if it is, to make payments into your nominated bank account.

You can find out more about how we collect and handle your personal information, and information about how to request access to of correction of the personal information we hold about you or make a complaint about a breach of your privacy by visiting our Privacy Policy at: ew. ndis gov. aulabout-us/polciesprvacy

The isa form 9A 45A ofthe insurance Scheme Act 2013. ft has been approved by the Cine! Executve Officer of the Nationa! Diaabitty Ineurance Apeney purtuart fo 2 GA(T) of thet Act

Stop! Look! Check!

A 2-week grace period has been implemented for self-managed claims submitted with an MSC form.

From 28 July where a participant of their authorised representative submits a manual self- managed claim it must be on the updated Participant Claim Form.

The new claim form is available from the NDIS website ndis.gov.au self-management

page — How you can pay for NDIS supports as a self-manaaer | NDIS

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For new CPE’s created from 28 July 2025, payments staff will be required to follow the request for information process to obtain an updated participant claim form from the participant or their authorised representative.

Payments triage officers will follow the Request Information/Provide Education Internal/External process and provide the Request for information — Updated MSC form required (Self-managed - Participant) or Request for information — Updated MSC form required (Self-managed - Authorised Representative) response.

Payments officers will follow the Request Information Internal/External and provide the

Request for information — Updated MSC form required (Self-managed - Participant) or Request for information — Updated MSC form required (Self-managed - Authorised Representative) responses.

When payments officers process manual self-managed claims for CPEs created up to 28 July 2025 with old MSC forms, they will provide an education response for future claiming with the updated form. e Paid - Closure and Education for updated MSC form (Self-Manaaqed - Participant e Paid - Closure and Education for updated MSC form (Self-Managed - Authorised

representative)

6.2.1 Manual Self-managed Claim Form Requirements

The new Manual Self-managed Claim (MSC) form must be completed correctly and in full, with a valid signature if it has been signed. If the form has not been signed, please see below.

e The signatory must be the participant, an authorised representative or a third-party with consent on file that specifically states they are able to act on the participants behalf and can submit payment requests.

Payments staff must confirm the following MSC form requirements to progress the CPE.

6.2.1.1. Participant and third-party (nominee or representative) details e Payments staff must confirm the following information is correct.

o Third-party (nominee or representative) details (full name, date of birth, third party NDIS number and relationship to participant).

o Participant details (full name, date of birth and participant NDIS number).

e Other parties are able to assist with filling out the form as long as the form is signed and submitted by someone with consent. If there is any doubt about the authenticity of the form, payments staff should contact the participant or authorised representative to confirm:

o Payments triage officers will refer to Phone a Participant or Provider for Payments Staff.

o Payments officers will refer to Phone a Participant or Provider for Payments Staff.

6.2.1.2 Valid signature or unsigned form e Both written and digital signatures are acceptable. If the participant or authorised representative is unable to sign, unsigned forms can be accepted.

6.2.1.3. Digital signature and unsigned form additional requirement

When a MSC form is submitted unsigned or with a digital signature it must be received from an email address registered on the participant or authorised representatives account to be accepted.

e The original email must be viewed to confirm it has been submitted from the registered email address. Note: Staff are unable to attach the original email to the CPE, when the NCC create the

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CPE, they will add the general enquiry case number as the parent case to enable staff to view these details.

o Payments triage officers will refer to Attaching and Locating Documents to understand how to locate and attach documents in PACE.

o Payments officers will refer to Attaching and locating documents to understand how to locate and attach documents in PACE.

6.2.1.4 Claim details • Payments staff must confirm the following information is completed in full.

o Payee (service provider)

o Payee’s ABN or exemption reason

o Support start and end date

o Support category

o Claim amount (GST inclusive)

o Description of support

6.2.1.5 Claim details on the MSC form match compliant invoice details • Confirm invoices attached are compliant refer to the invoice requirements for self- managed below.

• Verify that the purchase receipts or invoice details match the information provided on the form as requested. If there are any inconsistencies, you may need to contact the enquirer:

o Payments triage officers will refer to Phone a Participant or Provider for Payments Staff.

o Payments officers will refer to Phone a Participant or Provider for Payments Staff.

6.2.1.6 Incorrect form, form incomplete, no invoices Where the incorrect form has been submitted, form is incomplete and/or there are no purchase receipts/invoices, payments staff must request the required information to progress the CPE.

•

o Payments triage officers will refer to Request Information/Provide Education Internal/External.

o Payments officers must attempt to contact the participant or nominee by phone if listed as a contact method and refer to the additional information below.

In all instances when there is incomplete or missing information payments officers must: • o First attempt to phone the participant or their authorised representative if it is listed as a contact method before using email. Refer to Phone a Participant or Provider for Payments Staff and the Request Information Internal/External article for further information on contacting participants by phone and email. o If phone contact was successful or unsuccessful, email the participant or nominee to request the required information using the Request for Additional Information (Self-Managed) template. o Allow the participant or nominee 5 business days to return the required information and if not received send a follow up email Request for Additional Information Not Received - Follow Up (Self-Managed)

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fe)

If information is not received within the 24 hours outlined in the template use the Request for Additional Information Not Received - Closure (Self-

Managed)

Note for Payments Officers: If, upon review, you have identified that reasonable contact attempts have already been made by Payments Triage staff to request additional/missing information prior to assigning the CPE to the Payments Team, and a response has not been received, Payments Officers are only required to make one additional phone attempt and send one additional follow-up email requesting the missing information using the templates Request for Additional Information Not Received - Follow Up (Self-

Managed) or Request for Additional Information Not Received - Follow Up (Provider/Plan Managed).

If the information has still not been received after 24 hours, Payments Officers can then close the enquiry following the steps outlined in Payment Enquiry Closure and using the templates Request for Additional Information Not Received - Closure (Self- Managed) or Request for Additional Information Not received - Closure (Provider/Plan Managed).

6.2.2 Invoice Requirements Self-Managed

e Support dates (start and end)

e Support or item description

e Total amount claimable

Note: Support line-items are not required on invoices for self-managed participants. Purchase receipts or invoices only need to contain information that they would have provided if claiming in the Portal.

When processing payments in PACE a support line-item will need to be input by payments officers to represent a support item name and support category name in PACE.

6.3 Plan and Agency Managed

6.3.1 Invoice Requirements Plan and Agency Managed

Before a plan managed payment can be made, the plan manager must provide:

e the service provider’s ABN; or

e acompleted ATO Statement by a supplier form stating why they are exempt from providing an ABN.

The provider must provide invoices for supports provided. The invoice must contain:

e Business name or trading name (This may be the person’s name if they are a sole

trader)

e Participant’s name e NDIS number

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o Plan managers - If the NDIS number is not on the third-party providers invoice but the plan manager has provided it in the payment enquiry when submitting it, this is acceptable.

e Support dates (start and end) e Support item e Hours or quantity

e Unit price - refer to the NDIS Pricing Arrangements Note: If the unit price charged is above the unit price limit you can proceed however any payment will be capped at the unit price limit for agency or plan managed supports.

e Total amount claimable. o GST component if applicable

Unit price not specified

Note: If the unit price is not specified on the invoice, however the total amount claimed divided by the quantity or hours is at or below benchmark price this can be considered a compliant invoice.

Example Support Line item quantity unit total price Assistance With Decision Making Daily 15_035_010613 2 $124.34 Planning and Budgeting

The benchmark price for this support is $62.17. The total $124.34 divided by the quantity of 2 equals $62.17 which is the benchmark price.

Small variances due to rounding or hours to decimal conversion

If there are any small variances due to rounding or Invoice Hours to Decimal Conversion this would not be a reason to deem an invoice non-compliant, and request amended invoices. Small variances can be allowed and paid up to $1.00 per consolidated line item.

6.3.2 Date/s the support was delivered A provider’s invoice may list the supports delivered for each date per invoice line.

Alternatively, a provider’s invoice may provide a date range for a specific line item with the unit price and quantity on one invoice line.

Both are acceptable but consider the unit of measure a provider is claiming for e.g.: e Are they claiming for 136 hours of support within a 48-hour period for an hourly line item e Are they claiming for 40 days of support within 20-day range for a daily line item

There are no system validations currently in place to prevent this claiming, but we should query discrepancies.

Providers should not put a date range at the top of an invoice for multiple different, listed line items.

It may be that only one hour of support in total was delivered on one day for one particular line item. We would not input a range for the support date.

It is acceptable for invoices to contain support dates for different claim coverage periods or plans.

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e If a date range is used for a line item, and support dates cross over different claim coverage periods or plans we will need an invoice with a breakdown of dates.

Remember: We should not process agency and plan managed manual payments in a participant’s current claim coverage period.

If the line item used is for a specific day or time of day e.g. Saturday, Sunday, Public Holiday or Weekday evening does this correspond to the date, and time (if noted) on the invoice.

6.3.3 Activity Based Transport

If a provider incurs costs, in addition to the cost of a worker’s time, when accompanying and/or transporting participants in the community (such as road tolls, parking fees and the running costs of the vehicle), they may negotiate with the participant for them to make a reasonable contribution towards these costs. The following is a guide as to what these contributions might be:

e Fora vehicle that is not modified for accessibility, up to $0.97 a kilometre. e Fora vehicle that is modified for accessibility or a bus, up to $2.76 a kilometre.

e For other forms of transport or associated costs, such as road tolls, parking, and public transport fares, up to the full amount

While service agreements help to ensure a shared understanding of expectations, supports, responsibilities, obligations and problem resolution, Service agreements (external) explains that “A written service agreement is required for Specialist Disability Accommodation (SDA) supports under the NDIS rules. For other NDIS services, the NDIA does not require written service agreement”. Payments officers do not need to request a service agreement for Activity Based Transport.

If an invoice displays $1 for this line item (e.g., 04_590_0125 _6_1) and it doesn’t detail what it’s for e.g., km rate, road, tolls, parking, vehicle running costs please seek additional information from the provider including an updated invoice. If the km rate is higher than $0.97 per km or $2.76 for a vehicle that is modified for accessibility or a bus it may be worth investigating.

The policy around Activity Based Transport is about ‘reasonable contribution towards these costs. The figures of $0.97 and $2.76 are not price limits per se, but they are considered to be reasonable costs negotiated by provider and participant for delivering the support. The provider may travel 20 km at a negotiated price of $0.97 per km for a total amount of $19.40 (20*0.97).

In the provider portal, the payment request may involve one of the following methods for lodging that request:

$19.40 = $1.00 x 19.4 units
$19.40 = $0.97 x 20 units

The suggested figures of $0.97 and $2.76 do not necessary translate to precise claiming behaviour in the provider portal. Where a payments officer comes across a claim for $20 at 20km, then it might be worth investigating, but be mindful that the provider may be claiming additional costs such as road tolls, parking fees, etc.

6.3.4 Temporary Transformation Payment (TTP)

Eligible registered providers are able to claim a TTP (Temporary Transformation Payment) which is a higher rate than the standard price rates. A number of supports in the Assistance with Daily Living Support Category and the Social, Economic and Community Participation Support Category are in the scope of the TTP. These support line items end in ‘_T.’

In order to access the higher TTP price limits, providers must meet the following eligibility criteria:

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e they must publish their service prices prominently on their website, and make them available to participants, including participants who are not their clients, and the NDIA on request; and

e they must list their business contact details in the Provider Finder in the myplace portal and ensure that those details are kept up to date; and

e they must participate annually in a NDIA-approved market benchmarking survey.

Registered providers who meet these eligibility criteria are known as TTP providers. Payments staff do not need to a check if a provider is eligible for TTP but must ensure that they are a registered provider.

6.3.4.1. Plan managers e are not responsible for ensuring registered providers are TTP compliant. They can accept the claim for a TTP support item by a registered provider as proof of TTP compliance.

e are required to inform the NDIA, when requested, which registered providers have made a claim for a TTP support item through the plan manager.

e should not use TTP line items to claim for services delivered by non-registered providers. Non-registered providers are not eligible for the TTP

6.3.5 Provider Claim Form Requirements

Registered or deregistered providers can submit a provider claim form to request manual payment if they are unable to submit a claim or submit a CPE electronically.

Claiming through the portal remains the preferred submission channel.

Registered providers do not need to submit this form if they are able to submit a claim or submit a claim and payment enquiry via the portal.

Unregistered providers cannot use this form. Unregistered providers must submit their claim to a participant or their nominated plan manager.

e Claims submitted using this form will take longer to process than claims submitted through the portal.

e The provider claim form must be completed correctly and in full.

e If providers need to claim for more than one support line-item, they will need to complete a new form for each claim.

e Evidence must be provided to support each claim.

Stop! Look! Check! Before proceeding with the provider claim form checks, payments staff must first determine if the provider claim form is required.

e Payments triage officers will refer to Review the Documents

e Payments officers will refer to

Payments staff must confirm the following provider claim form requirements to progress the CPE.

6.3.5.1 Provider contacts details Payments staff must confirm the following information is correct.

e Provider details: (Provider name, provider number, ABN, Provider contact)Note: Other parties are able to assist with filling out the form as long as the form is signed and submitted by a provider contact.

If there is any doubt about the authenticity of the form, payments staff should contact the participant or authorised representative to confirm the supports:

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• Payments triage officers will refer to Phone a Participant or Provider for Payments Staff.

• Payments officers will refer to Phone a Participant or Provider for Payments Staff.

6.3.5.2 Valid signature or unsigned form • Both written and digital signatures are acceptable. • If the provider contact is unable to sign, unsigned forms can be accepted.

6.3.5.3 Digital signature and unsigned form additional requirement When PCFs are submitted unsigned or with a digital signature they must be received from an email address registered on the provider contact or provider account to be accepted.

• The original email must be viewed to confirm it has been submitted from the registered email address. Note: Staff are unable to attach the original email to the CPE, when the NCC create the CPE, they will add the general enquiry case number as the parent case to enable staff to view these details.

Payments triage officers will refer to Attaching and Locating Documents to understand how to locate and attach documents in PACE.

Payments officers will refer to Attaching and locating documents to understand how to locate and attach documents in PACE.

6.3.5.4 Claim details Payments staff must confirm the following information is completed in full.

Participant name Participant NDIS number

Support start date Support end date Invoice number

Support category Item number (Claim line-item Claim type number)

Cancellation reason Item quantity Unit of measure

ABN of support provider or exemption Payment amount (GST inclusive) GST reason

6.3.5.5 Claim details on the PCF match compliant invoice details • Confirm invoices attached are compliant refer to the invoice requirements for plan and agency managed above.

• Verify that the purchase receipts or invoice details match the information provided on the form as requested.

If there are any inconsistencies, payments staff will need to contact the enquirer:

Payments triage officers will refer to Phone a Participant or Provider for Payments Staff.

Payments officers will refer to Phone a Participant or Provider for Payments Staff.

6.3.5.6 Incorrect form, form incomplete, no invoices Where the incorrect form has been submitted, form is incomplete and/or there are no purchase receipts/invoices, payments staff must request the required information to progress the CPE.

Payments triage officers can refer to Request Information/Provide Education Internal/External for guidance.

Payments officers can refer to Request Information Internal/External for guidance.

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If phone contact is successful, you must inform them that you will follow up with an email request covering the required information and this will allow them to reply to the email and have the information attached directly to the CPE.

If phone contact is unsuccessful or preferred method of contact is not phone, you must follow the request for information process allowing the provider 5 business days to respond.

Payments officers can refer to Email a Participant or Provider for Payments Staff.

Payments triage officers can refer to Email a Participant or Provider for Payments Staff.

6.4 Related procedures or resources

• Self-Managed Payments • Request Information/Provide Education Internal/External

• Phone a Participant or Provider for Payments Staff • Email a Participant or Provider for Payments Staff • NDIS Pricing Arrangement (External) • Invoice Hours to Decimal Conversion • Service agreements (external)

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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ndis

Review the Claim and Payment Enquiry

This article provides guidance for a payments officer to:

e understand the steps required to review all claim and payment enquiries (CPEs)

e understand the enquiry fora SAP CRM plan

e understand the enquiry for a PACE plan

a Date What’s changed 30 October 2025 Short Term Respite (STR) annual limit information added Topic Checklist Pre-requisites @ Received a Claim and Payment Enquiry. Actions Sections:

@ Steps required to review claim and payment enquiries

e@ = =Enquiry for a PACE Plan @ = Enquiry for a SAP CRM Plan

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@ Complete Enquiry Closure

Additional Information

@ Related procedures or resources

Procedure

Section 45A(5) - 2-year claiming period Section 45A(5) introduced a 2-year claiming period for all NDIS supports, payments triage officers will need to check the earliest support start date on the invoice to determine if claims are within the 2-year period.

@ = Refer to Section 45A payment review for process information.

Steps required to review claim and payment enquiries

Initial Steps

After receiving the enquiry via the Omni-channel or by manual allocation, change the status of the CPE to “In Progress.” This is to ensure that the Omni-channel does not incorrectly show the work as un-assigned for other staff to select.

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Important If a different work type has been received via the Omni-channel that is not a CPE refer

to Non-Claim and Payment Enquiries in PACE queues for instructions.

Check PACE for related payment enquiries and consolidate any duplicate and related enquiries as necessary. Refer to article PACE related enquiries consolidation for detailed steps.

Note: If you have identified a potential duplicate account, follow steps in the article Manage a duplicate person account PACE knowledge article.

Navigate to the Details tab of the enquiry and review the Subject, Prioritisation comment and Description. Ensure prioritisation comment field aligns with the Naming and Categorisation guidelines.

Click here to view images

o Claim and Payment Enquiry

Account Name pe Pron Statu Case Nurmber Case Queer zz Within Budget Threshold Medium New <-> PaymentOfficer- Details Steps To Resolve Claims Documents Case Activity P Medium 2 Statu! New 4 — ‘ase Owner PaymentOfficer P 6/7/2024, 11:30 am i

( Cla g hin B 7 Ca Clai ¢ jt I Gr Pl 4 Ce nt i 4 Res Pay: [PACE] 43200000 ¢

Figure 1 Details Tab

Y System Information reated By PS PaymentOficer —«s-—=—-« 16/7202 4,14 a8 €3 PaymentOfficer 0 ” GCG 4 , Test Case ¢ r

Figure 2 Details Tab

Note: The subject and description will be entered by providers for enquiries submitted by the portal and may contain useful information but sometimes details may not be accurate so ensure you compare with provided documents and participant information.

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Review attached documents

Review attached documents by navigating to the Documents tab.

STOP, LOOK, CHECK

From 13 June 2025, Payments triage officers will send an email for every CPE they refer to the Claims and Payments Routing Queue. This email will allow participants and providers to reply with more information about their enquiry, without needing to submit a new CPE while the current one is still being reviewed.

As a result, CPEs might now include emails and attachments that were sent after the triage team referred the case to the payments team.

Payments officers should check both the Case Activity tab and the Documents tab to see if any emails have been received with extra information including invoices or Manual Self-Managed Claim (MSC) forms.

If new invoices have been received and an IAT (Invoice Analysis Tool) has already been created for the CPE, payments officers should add the new invoices to the existing IAT and continue reviewing the CPE. There’s no need to ask the triage team to re-run the IAT in these cases.

If the enquiry was originally submitted as an email to the National Contact Centre (NCC), a general enquiry case would have been created. The NCC will create a claim and payment enquiry where the issue is payment related. Staff are unable to attach the original email to the claim and payment enquiry, when the NCC create the claim and payment enquiry they will add the general enquiry case number as the parent case for the claim and payment enquiry to enable staff to view these details.

Click here to view images

o Claim and Payment Enquiry

Priority Statu ase Number

—_ Within Budget Threshold Medium New “<-> PaymentOfficer-

Details Steps To Resolve Claims Documents Case Activity P Medium ¢ i ¢ < ——— PaymentOfficer

, ti 16/7/20 24,11 , “ Categ ti r Claim and Payment Enquiry ¢ Type Within Budget Threshold ra Cal laiming rf jt Claim - Greater than available Plan Funds 4 Ce ntemal é li o 4 Ree mt [PACE] 43:000x2000x F

Figure 3 Details Tab ndis.gov.au 24 4

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If an MSC form and invoices are located in the original general enquiry case, you must attach the documents to the Claim and Payment Enquiry this can be done by linking the document or re-uploading. Please refer to Attaching and locating documents for further information.
Ensure the document related to the participant or provider account has not been uploaded to the incorrect account. If a document has been incorrectly uploaded, submit a request to the Privacy Service Desk to delete the documents, refer to article Delete a document from PACENote: The provider details including the employee’s name, mobile number, email, account manager name, role status, role start date and role end date are available in PACE. The employee list can be obtained from the provider account under the employee tab within the relationships tab.

Review the action required (Reason Category)

Determine if enquiry relates to CRM plan or PACE plan. On the Details screen the Reason Category should state one of the following:

e Payment (PACE) - Payments Triage identified the enquiry relates to PACE plan and meets requirements for potential payment resolution.

Stop! Look! Check!

When Payment (PACE) is selected a Link Claims function will become available for payments staff. This function will only be used for section 45(5) related CPEs.

Do not link claims to CPEs for any manual payments using other payment resolution processes.

e Payment (SAP) - Payments Triage identified the enquiry relates to CRM plan and meets requirements for potential payment resolution.

e Unsure if payment required - Payments Triage were unable to determine if payment was required and were unable to resolve.

Click here to view images

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Figure 4 Details Tab

The Reason Category is linked to the ‘What action is required?’ entry on the Steps To Resolve tab. Once the Claim and Payment Enquiry has the status changed to “In Progress” you will not be able to save the status as Payment (SAP) or Payment (PACE) as the button will change to a “Next” button prompting you to enter payment details.

Click here to view images

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Figure 5 Steps To Resolve tab

For reporting purposes you may need to update the action required before you are ready to action the payment. To do this:

Change the status of the case back to ‘New’ and then save.
Proceed to the Steps to Resolve tab and change the action required appropriately and select Save.
Once this is done you can update the status of the Claim and Payment Enquiry back to ‘In Progress’.

If action required was not selected, the payments officer will need to check PACE for a current plan period. Review plan dates to determine if the invoice dates relate to a PACE or CRM plan. When this has been determined the payments officer will select the appropriate action required.

Review Invoice Details and Invoice Analysis Tool (IAT)

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Review invoice support item details and dates against the participant’s relevant claim coverage/CRM plan and approved supports.
Ensure invoice/MSC meets requirements - refer to Invoice and Manual Claim Form Requirements for details. Note: If the invoice/MSC is not compliant then first determine if a manual claim would be processed before requesting an amended invoice/MSC. You should only request an invoice prior to determining if payment is required if no invoice was provided or you are unable to determine the potential payment with the current invoice, e.g. dates are missing so you are unable to determine which plan it relates to.

Request for Additional Information Not Received - Follow Up (Self-Managed) or Request for Additional Information Not Received - Follow Up (Provider/Plan Managed).

If the information has still not been received after 24 hours, Payments Officers can then close the enquiry following the steps outlined in Payment Enquiry Closure and using the templates

Request for Additional Information Not Received - Closure (Self-Managed) or Request for Additional Information Not received - Closure (Provider/Plan Managed).

Check if there is an Invoice Analysis Tool (IAT) saved in SharePoint and review the details.

Note: If it has been identified within the CPE that an IAT has been generated by a payments triage officer, payments officers must use the IAT to support any manual claims being processed. If no IAT was created and invoices are compliant, then refer to Invoice Analysis Tool (IAT) Overview for further information on how to request or create one.

Ensure supports provided on or after 3 October 2024 are an NDIS support.

NDIS Supports

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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

@ 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.

Once you have completed an initial analysis and determined if the enquiry relates to a PACE or CRM plan then you can proceed to the below section and review the appropriate guidance.

Note: If the claim and payment enquiry has been raised on the incorrect account, the CPE will need to be assigned to the correct record and any documents incorrectly placed on the participant or provider account remediated. The payments officer will then be able to progress the claim and payment enquiry.

Short Term Respite (STR)

When Short Term Respite (STR) claims are identified, payment officers must review the participant’s claiming history to ensure claims, do not exceed the annual limit of 28 days or the consecutive limit of 14 days for this support type. For more information, refer to Our Guidelines.

Enquiry for a PACE Plan

Plans commencing 9th October 2024

Plans approved from the 9th of October 2024 (in PACE) are built with s33 funding limits and funding periods and are also subject to s45 which restricts payments officers from processing manual claims when the payment exceeds the participants funding limits without Delegate approval in exceptional circumstances.

Payments Officers will not be able to process manual payments when the payment exceeds the Participant’s funding limit without Delegate approval.

Note: This does not include payments due to system limitations or Planner errors where the funding was approved but not correctly applied in the system.

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Payments staff will progress these CPEs for s45 review. e@ Payments triage officers will follow the steps outlined in Section 45(5) Payment Review @ Payments officers will follow the steps outlined in Section 45(5) Payment Review

Where the CPE relates to another issue identifiable within the CPE or on the participant or provider accounts the CPE should be progressed in accordance with the relevant resolution process. Examples: e@ Plan build errors - Funds were included in plan incorrectly Rejected Payments - not related to funds exhausted/overspends Recurring Transport related issues Bank account and Nominee account issues MSC form processing for Self-Managed participants - funds are available Unregistered and Deregistered Provider Enquiries Provider and Plan Manager Relationship Enquiries

Bulk upload error enquiries

Cancelled payments

Review Participant Budget

Review participant’s PACE budget and plan management. Refer to Review the budget for further information.

Ensure plan management type matches with who is claiming the support (Provider/Plan Manager/Participant/Nominee etc).
Check remaining funds for claimed supports.
If sufficient funds are available in the participant’s plan and the plan management type aligns with who is claiming the support, consider providing education on how to claim for supports.

Review approved Providers (Agency/Plan Managed Supports)

Approved providers can be found in the Participant’s person account under the Relationships tab and the Providers sub tab.

Click here to view images

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Figure 6 Relationships tab

Review the approved provider’s role, support category and relationship start and end date. Also, ensure the dates align with the support period being claimed.

Most supports can be claimed as long as the provider relationship is present and the category aligns with the plan management type and the role of the provider relationship (e.g. Plan Manager or my provider roles). Some specific supports such as Home and Living need to have a provider relationship implemented specifying the category in order to be able to claim.

Where the provider is not an approved provider:

Check claims history to determine if the relevant claims are recorded with a status of pending verification, pending review or payment declined. Refer to Review Claim History PACE - Claim Line Items List User Guide for further information.

Payments officers must not create a manual claim where these statuses are displayed.

In these cases, the participant/provider will be contacted by a claim review officer for further investigation. Payments staff can relay the information about the status of the claim back to the provider/participant as this information has been disclosed by a claim review officer.

No further action is required by the payments staff to resolve these issues.

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If there are no claims with these statuses in the claim history, proceed with the following steps:

Contact the participant to confirm the supports were delivered and they agree to pay the provider for the supports.
Create an internal note or outbound phone call note to record the confirmation from the participant, refer to Phone a Participant or Provider for Payments Staff and Create and view internal notes.
If the provider relationship is missing or does not align with the support dates being claimed, create an internal referral to the Core Planning Enquiry Routing Queue. Refer to Service Delivery - Internal Staff Referral for more guidance.
Provide the participant with education on approved providers and impacts to future claiming if the relationship is not created.
Where the enquiry requires a manual claim, the payment validation approved provider can be bypassed.

Check for Duplicate or Rejected payments

After the July PACE enhancement full claim history lists are no longer viewable from the Participant Person Account and the Claim Line Items List must be used. Refer to Review Claim History PACE - Claim Line Items List User Guide for further information.

• If the payee has already claimed for the same support item on the same support date, for the same $ Amount, it will most likely identify as a duplicate payment.

• If duplicate claims are found, request information from the payee to determine if it is a true duplicate.

• The validation field within the claim details will provide insight into the claim rejection reason. Refer to Claim Validation Guide - Rejection Error Codes.

Determine next steps and if Payment is Required

Consider if there is enough information to proceed with the enquiry and request information if necessary. Refer to Request Information Internal/External and follow the Phone First approach and instructions on emailing providers/participants.

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Determine if a manual claim is required. Determine the resolution - PACE plans provides further information on PACE plan resolutions.
If a payment is required ensure you have checked and obtained an IAT if required and then follow the Create a Claim and Request Authorisation (PACE) guide.
If a payment is not required - consider providing advice or response to the enquirer as appropriate and select the “no payment required (education or duplicate)” option in the action required section under the Steps To Resolve tab.

Enquiry for a SAP CRM Plan

Navigate to CRM to view the participant’s plan details. For further information refer to Review the CRM Plan Funding and Invoice or MSC Form.
Review the enquiry to determine if a payment is required, refer to Determine Resolution Process CRM Plans.
Check for duplicate or rejected payments, refer to Checking for Duplicate Payments Help Card for instructions.
Consider if there is enough information to proceed with the enquiry and request information if necessary. Refer to Request Information Internal/External and follow the Phone First approach and instructions on emailing providers/participants.
If a manual payment is required – follow the instructions in the Request Payment Authorisation for a CRM Plan article.
If a manual payment is not required – change the action required within the Steps To Resolve tab of the claim and payment enquiry to no payment required (education or duplicate).

Complete Enquiry Closure

After completing the payment and authorisation process for either a SAP CRM or PACE plan OR Determining no payment is required:

Notify the enquirer of the outcome.

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Proceed through the Steps To Resolve tab to finalize claim and payment enquiry closure.

Refer to Payment Enquiry Closure for detailed instructions.

Related procedures or resources

• NDIS Supports Section 10

• PACE related enquiries consolidation

• Naming and Categorisation guidelines

• Attaching and locating documents

• Delete a document from PACE

• Invoice and Manual Claim Form Requirements

• Review the budget

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

• Claim Validation Guide - Rejection Error Codes

• Request Information Internal/External

• Phone a Participant or Provider for Payments Staff

• Create and view internal notes

• Service Delivery - Internal Staff Referral

• Determine the resolution - PACE plans

• Create a Claim and Request Authorisation (PACE)

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• Payment Enquiry Closure

CRM Plan Processes

• Review the CRM Plan Funding and Invoice or MSC Form

• Determine Resolution Process CRM Plans

• CRM Resolution Processes

• Checking for Duplicate Payments Help Card

• Request Payment Authorisation for a CRM Plan

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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