Image credits to Marcus Aurelius from Pexels
New NDIA Checks on Older Claims: What You Need to Know
These checks are designed to ensure that claims meet NDIS requirements and are supported by the appropriate documentation.
What is changing?
Initially, the NDIA will review claims that are submitted more than 12 months after a support was delivered. Over the coming months, these checks will also apply to claims submitted more than 6 months after a support was delivered.
The checks will apply to claims submitted by participants, plan managers and providers.
What does this mean?
If an older claim is submitted, the NDIA may place it on hold while completing a review. These reviews can take up to 28 days.
During this time, the NDIA may:
- Review the claim to ensure it relates to an NDIS-funded support
- Request additional information or evidence
- Approve or reject the claim based on the information provided
If additional information is required, the NDIA will contact the party responsible for the claim.
Will this affect current supports?
For most participants and providers, there should be little to no impact.
However, claims submitted many months after a support has been delivered may take longer to process while the NDIA completes its review.
How can I help avoid delays?
For participants and nominees
- If you receive invoices directly, send them to your plan manager promptly.
- Encourage your providers to submit invoices as soon as possible after supports are delivered.
- Be aware that older invoices may take longer to process if they are selected for NDIA review.
For providers
- Submit invoices as soon as possible after supports have been delivered.
- Ensure invoices contain all required information such as item code(s), service date(s), quantity, unit price.
- Respond promptly if further information is requested by the NDIA.
Timely invoicing and claiming helps reduce delays and supports faster payment outcomes for everyone involved.
What does this mean for plan-managed participants?
As your plan manager, we will continue to submit claims on your behalf and monitor their progress.
Where the NDIA places a claim on hold for review, payment cannot be released until the claim has been approved and funds have been received from the NDIA.
If the NDIA requests further information, we will work with participants and providers to help resolve the matter as quickly as possible.
Need help?
If you have questions about an invoice, claim, or how these changes may affect you, please contact our team on 1300 770 986 or email us at contact@aspectndis.com.au . We’re here to help.
