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Claims with Issues

View claims with issues that need to be addressed.

Claims with Issues This will identify any claim with an issue that needs to be addressed. These are claims that are in an approved or entered status that:

  • has at least one rejected claim line;
  • and/or at least one claim line where an exception was raised by NDIS which has prevented the provision of a PRN.
  • and/or a short paid claim line that may require an adjustment claim. 
  • was approved but still held for review which has prevented the claim from submitting
  • no action taken on approval request (if agency setting is to move claim to claims with issues instead of auto-submitting). 
  • no NDIS payment status update received within 10 days after submitting

If the response from NDIS to a submitted claim is either a rejection or an exception, the claim will be displayed in the list until the issue has been rectified.

You can elect to Edit the claim, or Cancel the Claim.

Claim lines that have been short paid by more than $1.00 will display an option to add an adjustment claim. This is generally handled at the time of submission, but during the period that the adjustment is available and until the amount has been claimed, the claim will be added to the Claims with Issues list as it requires attention.

NOTE: If a claim line has been short paid and you do not add an adjustment claim before the NDIS processes the payment, the claim will be removed from the Claims with Issues list, and you will lose the opportunity to submit an adjustment claim for that line.

(An automatic adjustment will be applied if the amount is <= $1.00).

Claims with Issues: when no NDIS update received within 10 day window

If the NDIS has not updated the status of a submitted claim to "NDIS Paid" within 10 days, the claim will automatically be moved to the Claims with Issues section. This helps you to effectively monitor claims that might require attention.

After 10 days the software will stop automatically checking for updates on the claim.

Directors and Plan Managers with elevated Claims permission will be able to request an NDIS payment status update from the Claim Details page. 

You will need to refresh the page after using the Check NDIS payment status to load any update to the status.

Claims with Issues is different to Override claims. Override Claims holds claims that have a rejected or cancelled claim line. They need to be checked and updated and/or payment enabled. 

 

Next Read: Override Claims