FOI 25/26-0018 DOCUMENT 8

Over Budget - CRM Tier 3 Manual Payments

This article provides guidance for a payments officer to:

Review and determine eligibility for a CRM Tier 3 manual payment consideration.

Recent updates

Date	What’s changed
27 May 2025	Broken links fixed

Checklist

Topic	Checklist
Prerequisites	- Before a plan managed payment can be made, the plan manager must provide:

the service provider’s ABN; or
a completed ATO statement by a supplier form stating why they are exempt from providing an ABN.
The provider or participant must have submitted a payment enquiry.
The payment request must be for an old/expired plan.
The participant must have submitted a Manual Self-Management Claim (MSC) form and invoices for self-managed claims unless the Tier 3 manual payment relates to Periodic Transport
The provider must provide invoices for supports provided. The invoice must contain:
- NDIS number (not required for invoices submitted by self-managed participants)
- Support dates (start and end)
- Support item
- Hours / quantity
- Unit price
- Total amount claimable.
NOTE: Date of birth is no longer a requirement on the invoice.
The support provided must not have already been paid or have a payment request awaiting approval.
Where a participant’s circumstances have changed resulting in over expenditure the following must have occurred:
- Change of Circumstance must have been submitted by the participant
- Change of Circumstance must have been approved by the planning delegate
- A plan reassessment must have been undertaken in line with the Change of Circumstance.
If the enquiry is related to a participant with compensation recovery amounts or compensation reduction amounts an overspend should only be considered for a Tier 3 manual payment with very strong evidence and planner endorsement, or otherwise declined.
If the enquiry is related to a deregistered provider’s claim(s) for a participant’s current plan and they are unable to claim themselves the Tier 3 manual payment process can be considered. | | Actions | - Checklist
Overview
Important Messages
- Participant Personal Information Requirements
- Administrative Review Tribunal (ART) Claim and Payment Enquiries
- Plan Manager Invoices
Review and Assess the Enquiry

Additional Information

Related procedures or resources |

Overview

The purpose of this article is to define the process to be used by payments staff to review and process requests for manual payment processed by Public Sector Collections and Disbursements (PSCD). The approval delegation for a Tier 3 manual payment is determined according to the Authorisation Matrix: Claims and Payments Branch

This resolution process can be used where an enquiry includes a request for payment for services provided in certain circumstances, where the NDIS Business System (CRM) behaviours or administrative defects are preventing legitimate payment requests from being processed. This process can be used in other circumstances where a participants circumstances changed after their plan was approved which required a higher level of supports resulting in an impact to the participant’s NDIS funding.

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Authorisation Matrix: Claims and Payments Branch
Consent Phone Enquiry KA
Invoice and Manual Claim Form Requirements
CRM plan Claim and Payment Enquiry Analysis
Over Budget - Tier 3 Payment Requirements CRM Plan
Tier 3 Manual Payment Process Scenarios
Checking for Duplicate Payments Help Card
Reviewing the IAT for a CRM plan
Claims and Payments Forms
Complete the Authorisation Form
Phone a Participant or Provider for Payments Staff
Outbound Phone Call Interactions.
Payments Email Response Templates

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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Manual self-management claim form requirements

The Manual Self-management 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.

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.

You must confirm the following MSC form requirements to progress the CPE.

Participant and third-party (nominee or representative) details

Confirm the following information is correct.
- Participant details (full name, date of birth and participant NDIS number).
- Third-party (nominee or representative) details (full name, date of birth, third party NDIS number and relationship to participant).
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:
- Refer to Phone a Participant or Provider for Payments Staff .

Valid signature or unsigned form

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

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.

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.
- Refer to Attaching and locating documents to understand how to locate and attach documents in PACE.

Claim details

Confirm the following information is completed in full.
- Payee (service provider)
- Payee’s ABN or exemption reason
- Support start and end date
- Support category
- Claim amount (GST inclusive)
- Description of support

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 will need to contact the enquirer:
- Refer to Phone a Participant or Provider for Payments Staff .

Incorrect form, form incomplete, no invoices

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

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

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Once a deregistered provider loses their provider portal access, they will no longer be able to submit claims or create service bookings.

They will be required to submit provider claim forms for each of their claims.

Unregistered providers

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

Claiming through the portal remains the preferred submission channel.

Claims submitted using this form will take longer to process than claims submitted through the portal.
The provider claim form must be completed correctly and in full.
If providers need to claim for more than one support line-item, they will need to complete a new form for each claim.
Evidence must be provided to support each claim.

Confirm the following provider claim form requirements to progress the CPE.

Provider contacts details

Confirm the following information is correct.

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.
- Refer to Phone a Participant or Provider for Payments Staff .

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.

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.
- Refer to Attaching and locating documents to understand how to locate and attach documents in PACE.

Claim details

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 number)	Claim type
Cancellation reason	Item quantity	Unit of measure
ABN of support provider or exemption reason	Payment amount (GST inclusive)	GST

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, you will need to contact the enquirer:
- Refer to Phone a Participant or Provider for Payments Staff .

Incorrect form, form incomplete, no invoices

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

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Refer to Request Information Internal/External for guidance.

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.

Refer to Email a Participant or Provider for Payments Staff .

Phone a Participant or Provider for Payments Staff
Email a participant or provider for payments staff
Duplicates, Non-Compliant Invoices/ MSC form and Requesting Invoices
Payments Team Feedback
NDIS Pricing Arrangements
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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Omni-Channel - Status / Omni-Channel - Work Inbox

Understand the queues for payment enquiries

Payment Enquiry Triage Routing Queue

All new claim and payment enquiries (except for escalations) will be routed to the Payment Enquiry Triage Routing Queue to be reviewed by NCC Payments Triage Officers (PTO’s). PTO’s will identify and resolve any in scope enquiries. Out-of-Scope enquiries requiring Payments Officer analysis will be recategorised and routed to the relevant payments related routing queue.

Claim and payment enquiry routing queue

Where an enquiry is deemed out of scope for resolution by a PTO, or meets the pre-requisites for manual payment review, the PTO will assign the enquiry to the Claim and Payment Enquiry Routing Queue for actioning by a payments officer.

Payments Escalations Routing Queue

Where a claim and payment enquiry is created with an escalation categorisation, the enquiry will route to the Payment Escalation Routing Queue for resolution by appropriately skilled payments officers.

Payment Authorisation Routing Queue

When payments staff submit a payment for approval within their claim and payment enquiry for a PACE plan, the case will automatically route to the Payment Authorisation Routing Queue for approval or rejection by a payment authorisations skilled payments officer. Note: CRM plan payments require a task to be created to request quality check and approval.

RA Payment Enquiry Triage Routing Queue

Payment enquiries related to Restricted Access Participants will be routed to the RA Payment Enquiry Triage Routing Queue to be reviewed by Payments Officers with the required Restricted Access Permissions to action the CPE.

RA Payments Escalation Routing Queue

Where payments staff identify an Escalated CPE related to a Restricted Access Participant, these CPE’s will be routed to the RA Payments Escalation Routing Queue to be reviewed as a priority by Escalations trained Payments Officers with the required Restricted Access Permissions to action the CPE.

Manually assign cases to payments staff

When a user seeks to manually assign a claim and payment enquiry to a queue, a payments triage officer, or a payments officer, they can change the case owner to the appropriate queue , or they can input the staff member’s name to assign to the payments officer.

Note: Claim and Payment Enquiries should always remain assigned to the appropriate queue and not assigned directly to individual staff unless otherwise instructed for a specific enquiry type.

Select Change Case Owner
Select User or Queue and then assign appropriately

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Claim and payment enquiry (CPE) details screen

The details screen within the claim and payment enquiry (CPE) contains information related to the submitted claim and payment enquiry.

Contact name: Contact name in the CPE will indicate the name of the person enquiring. This can be the provider, participant or nominee who has made the enquiry.

Account Name: If the participant or nominee is the enquiring party it will contains the related participant accounts details. If the provider is the enquiring party this indicates the organisation details of the provider.

Case number: Claim and payment enquiry number.

Priority: Enquiry priority level.

Status: Current position on the CPE progression.

Case owner: Name of Staff or Queue the CPE currently assigned to.

Claim and payment enquiry status

The status of a claim and payment enquiry is indicated at the top of the screen within the chevrons, statuses include:

New: enquiry is awaiting acceptance by payments staff. If the claim and payment enquiry has been accepted and the status of the enquiry is new, the payments staff will need to change the status to in progress within the details tab.
In progress: enquiry is assigned to payment triage officer or payments officer.
Request further information: payment staff have requested further information.
Pending outcome: enquiry is awaiting payment authorisation.
Finalise: claim/s have been approved by the authorising officer.
Closed: enquiry has been closed; no additional information can be added to the enquiry.

To change the status of a Claim and Payment Enquiry, select the Status dropdown in the Details section and select the appropriate option from the list.

Claim and payment enquiry history

Claim and payment enquiry history can be viewed within the case activity tab.

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The Case Activity tab contains:

Open Activities related to the claim and payment enquiry.
Activity history
The claim and payment enquiry case team i.e., requesting officer and authorising officer.
Case notes and Emails
Related Cases
Claims linked to the Claim and Payment Enquiry

Related procedures or resources

Create a new claim and payment enquiry
Create an Escalated Claim and Payment Enquiry

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.