All claims that have been created by scanning or csv import will be held for review. You can also manually hold a claim that is entered, or submitted to the NDIS to prevent it from automatically processing further.
Table of Contents:
Claims > Claims for Review
Hold for Review - Manual Hold
Hold Submitted Claims
The Hold for Review function is available to both Plan Managers and Director Users.
When Held for Review:
- an entered claim cannot be submitted to the NDIS until it has been manually Marked as Reviewed.
- a claim sent for approval will not submit automatically when approved. The approved claim will appear in Claims with Issues and Claims for Review / Manually Held.
- a submitted claim will be withheld from Payments when marked as NDIS Paid.
Claims > Claims for Review
All claims held for Review can be viewed and accessed from Claims > Claims for Review under the relevant tab: Bulk Import; CSV Import; Manually Held; Scanned for Review
To enable an entered claim to be submitted to NDIS it needs to be Marked as Reviewed which releases it from being held, and then it can be submitted.
NOTE: Claims that are Held for Review when requesting Approval will not submit automatically upon Approval, and will need to be Marked as Reviewed before submitting manually or by Batch Claim.
Hold for Review - Manual Hold
When manually selecting Hold for Review you will need to select a reason from the options given and enter an optional note.
If a claim was initially scanned and remains on hold for review, but you wish to manually place it on hold to prevent further processing, you must first mark it as reviewed. After doing so, you can then proceed to manually hold the claim for review.
To Hold for Review:
- click Hold for Review
- select a reason from the pull down menu.
- enter a note
The Review Reason will display in the Claim Details until Marked as Reviewed.
and the reason is also visible from the Claims for Review - Manually Held tab:
If you do not have an option to select a Hold for Review reason and would like this feature, please contact support@credsys.com.au to have it enabled on your account
Hold Submitted Claims (recommended if being reviewed by Payment Integrity Team)
Submitted claims can now be manually held from processing to the Provider Payment stage by placing on Hold for Review.
We see instances where claims that are being reviewed by the NDIS Payment Integrity Team and later refused are initially updated by the NDIS as Paid and then immediately cancelled. Planability receives the NDIS Paid update via the NDIS APIs, but there is not currently an API to provide a second status update. Without intervention, the claim will be made payable to the Provider, when in fact it should not be - you will not have received payment.
We recommend that you place any claim that you are aware of or suspect of being reviewed by the NDIS Payment Integrity Team.
When the claim is udpated as NDIS Paid. Check the status of the claim lines in PRODA by clicking on the PRN in Planability. (This will take you to the PRODA claim line)
- If the claim is showing as PAID in PRODA, you can mark it as reviewed in Planabililty to release it, allowing it to flow to Payments.
- If the claim is showing as Cancelled in PRODA, contact the Planability Support team for assistance.
Claims that have been manually held after submitting to the NDIS will not automatically flow to the Create Payment Batch listing whilst held, and will be instead be listed in Claims for Review > Manually Held for Review tab.
See also: Review Claims
Claim Approval Settings