Understand provider relationships | FOI document library

FOI 24/25-1459 Disclosure Log

DOCUMENT 7

Understand provider relationships SGP KP Publishing

Exported on 2025-03-12 21:57:23

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FOI 24/25-1459 DisclosureSGP KPLogPublishing – Understand provider relationships

Table of Contents

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

2 Before you start …………………………………………………………………………………………………….. 5

3 Understand provider relationships ………………………………………………………………………… 6 3.1 Provider roles and relationships …………………………………………………………………………….. 6 3.1.1 My provider ………………………………………………………………………………………………………………….. 6 3.1.2 My provider – specified support category (home and living, specialist disability accommodation (SDA) or behaviour support) …………………………………………………………………………………………………………. 6 3.1.3 Registered plan manager ……………………………………………………………………………………………….. 6 3.1.4 Support coordinator ………………………………………………………………………………………………………. 6 3.1.5 Psychosocial recovery coach (recovery coach) …………………………………………………………………. 7 3.2 Review the participant’s plan management type ………………………………………………………. 7

4 Understand what happens with existing provider relationships when the participant transitions to PACE ……………………………………………………………………………………………………… 8

5 Record a provider relationship ………………………………………………………………………………. 9

6 Confirm a request from a provider ……………………………………………………………………….. 10

7 Next steps …………………………………………………………………………………………………………… 11

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FOI 24/25-1459 DisclosureSGP KPLogPublishing – Understand provider relationships

This article provides guidance for a planner delegate, planner (non-partnered area), review officer, complaints officer, participant support officer, access delegate, technical advisor, local area coordinator, early childhood partner, and the National Contact Centre to:  understand provider relationships  understand what happens with existing provider relationships when the participant transitions to PACE  record a provider relationship  confirm a request from a provider.

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1 Recent updates

16 September 2024 Guidance updated to:  explain participants with Agency-managed funds to pay for NDIS supports, can accept or decline provider relationship requests in their my NDIS participant portal  explain participants with Agency-managed funds to pay for NDIS supports, can change the information they consent to share with providers in their my NDIS participant portal  add link to new article my NDIS portal – Understand provider relationships and consent to share information  remove retired article Understand the product catalogue  add article Support Categories.

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2 Before you start

You have read and understood:  Our Guideline – Your plan (external)  the role of the NDIS Quality and Safeguards Commission (external)  article Connect with providers  article Support Categories  article Understand sharing the participant’s plan information with providers.

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3 Understand provider relationships

A provider is a person, business or organisation who delivers NDIS funded supports to participants. Providers have different areas of experience and expertise. They can be either registered or unregistered. To learn more, go to What is a provider? (external).

Participants have the right to choose their own providers. While you can inform the participant and help them understand their options, you can’t suggest specific providers.

We create provider relationships to allow the:  participant’s information to be shared securely with the provider through the my NDIS provider portal  provider to submit claims without asking for the participant’s approval every time.

3.1 Provider roles and relationships

PACE uses the following provider roles and relationships. Providers can have different roles for different support categories.

3.1.1 My provider

A registered provider the participant has chosen to claim and receive payment for NDIS supports that have Agency-managed funding. The nominated provider can submit claims without asking for the participant’s approval for each claim.

Note: If a provider who is not a my provider makes a claim, the participant (or their authorised representative) will be notified by SMS. The participant can accept or dispute the claim in the my NDIS participant portal or by contacting the National Contact Centre. To learn more, go to article Understand claim verification.

3.1.2 My provider – specified support category (home and living, specialist disability accommodation (SDA) or behaviour support)

A registered provider who supports the participant in one of the listed support categories. The nominated provider can submit claims without asking for the participant’s approval for each claim.

Note: A my provider relationship for the correct support category is mandatory for supported independent living (SIL), SDA or behaviour support. Claims made for these supports by providers without the correct relationship will be rejected.

3.1.3 Registered plan manager

A registered plan manager helps the participant manage their funding. They’ll pay the participant’s registered and unregistered providers. We can include funding to pay for a plan manager. Participants can only choose one plan manager to help them manage their funding.

3.1.4 Support coordinator

A support coordinator will help the participant connect to other supports. They’ll help the participant understand how to make the most of their plan. We’ll include funding for a support coordinator if it meets the NDIS funding criteria.

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3.1.5 Psychosocial recovery coach (recovery coach)

A recovery coach will help the participant gain maximum benefit from their plan. We’ll include funding for a recovery coach if the participant’s primary disability is a psychosocial disability. We’ll do this when it’s reasonable and necessary to do so. Learn more about support coordinators or recovery coaches in article Request for service overview.

3.2 Review the participant’s plan management type

Participants can manage their plan funding in three ways:  Agency-managed  using a registered plan manager  self-managed.

They may also have a mix of these options. Learn more at Ways to manage your funding (external). Some provider relationships are only used for specific plan management types.

In PACE, you can find and review the participant’s plan management type:

From the Person Account select the My Budget tab.
View the Budget Overview tab to confirm the Fund Management Type.

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4 Understand what happens with existing provider relationships when the participant transitions to PACE

Some provider roles and relationships will be created automatically when a participant transitions to PACE. The system will create these relationships when the participant had an active service booking in SAP CRM and has funding for the support category in their new plan. Note: It may take up to 5 minutes for relationships to be created after the plan is approved. Relationships will be created automatically for:  registered plan manager – PACE will add a registered plan manager relationship when the participant has an active service booking with a single provider  my provider – PACE will add a my provider relationship with no specified support category for any providers with active service bookings  SIL – PACE will add a my provider relationship for the support category home and living, as well as a general my provider relationship  SDA – PACE will add a my provider relationship for the support category SDA, as well as a general my provider relationship  behaviour support – PACE will add a my provider relationship for the support category behaviour support, as well as a general my provider relationship.

Check these relationships have been created correctly. You can check these from the participant’s Person Account in the Relationships tab. If you need to add or change a relationship, go to article [[Add or update a provider relationship](/foi-library/releases/25ee9a6cf986-foi-24-25-1942-document-disclosure-log/document-003__add-or-update-a-provider-relationship/)](/foi-library/releases/25ee9a6cf986-foi-24-25-1942-document-disclosure-log/document-003__add-or-update-a-provider-relationship/).

Talk with the participant to confirm they:  want to continue using their current provider. If the participant wants to change providers, you’ll need to end the relationship that has been created automatically. Go to article Add or update a provider relationship  understand what information the provider can view in their plan. Learn more about what information providers can view in article Understand sharing the participant’s plan information with providers. Note: When a relationship is automatically created, the provider will only be able to see the minimum amount of plan information for the role. If the participant wants to give their provider consent to see more plan information, go to article Add or update a provider relationship.

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5 Record a provider relationship

The manage provider relationship case is where you can add or edit a relationship between the participant and a provider.

You can record a provider relationship when the support category is Agency-managed or if the participant is using a registered plan manager.

You can’t use the manage provider relationship case to create a relationship with an unregistered provider.

Learn more about registered and unregistered providers in article Connect with providers.

You need to create several relationships if the participant is using more than one provider for their Agency-managed supports. This allows different providers to submit claims without asking for the participant’s approval each time.

Note: The participant can only have one registered plan manager at a time. You need to end the relationship with the existing provider before you can add a new registered plan manager.

To record or edit a provider relationship, go to article Add or update a provider relationship.

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6 Confirm a request from a provider

Registered providers and registered plan managers can use the my NDIS provider portal to send a proposal to create, change or end a relationship with the participant.

Participants who have Agency-managed funds to pay for NDIS supports can accept or decline provider relationship requests in the my NDIS participant portal.

Note: They can only view and accept relationship requests that have been sent from the my NDIS provider portal.

Help the participant do this using article my NDIS portal – Understand provider relationships and consent to share information.

Use the manage provider relationship case to confirm a provider’s proposal to add, edit or end a relationship with the participant.

For cases created through the my NDIS provider portal, talk with the participant or their authorised representative to ask if they consent to this relationship.

Participants can also change the information they consent to share with their providers in the my NDIS participant portal. Help the participant do this using article my NDIS portal – Understand provider relationships and consent to share information.

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7 Next steps

To create or change a provider relationship, go to article Add or update a provider relationship.

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