Claims
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      1. Customer Help Centre
      2. Plan Management
      3. Claims

      Create a Claim: Manual Input

      Create a Claim by entering manually or by scanning

      Table of Contents

      Create Claim

      Add Line Item

      Select Service Booking (required if there are two Service Bookings - a Stated Item and a Category Service Booking)

      Review and Submit Claim

      Create a single Claim - Overview

      You can start a new claim from any page or view in the platform. 

      Hover over the Create Claim button and choose to enter a claim for either a Provider or a Participant reimbursement.

      Create Claim

      • Upload the Invoice file by drag and drop into the Select File field, or click on the icon to browse for the file. The Invoice will display in the File Preview. 
      • Enter the Participant name. The most current plan will display, select an earlier plan from the pull down menu if required. 


      • Enter the Provider name (by either name or ABN). The ABN and bank details will display so that you can check them against the details given on the invoice.
      • Enter the Invoice date and number. 
      • If there is a Service Agreement entered for this Provider, you will have the option to 'Use Provider Service Agreement'.
      • Click Next.
      • To select an Approver for this claim, click on the Edit (pencil) icon.
      • Select an Approver if required. 

      Add Line Item

      • Click 'Add Line Item'



      • If there are multiple items with the same Item Code, aggregate them and enter them as one Line Item. Enter the earliest date from the invoice items as the Support Start Date. Enter the latest date from the invoice items as the Support End Date. These Dates must fall within the Plan Dates. 

      In NDIS APIs, there is a rule that says you cannot claim the same service dates, Support Item, GST and Claim Type on the same invoice. If you did, it would be rejected at the time of claim. In some cases, this is needed, for example, when you might need to claim a few extra cents to solve the rounding up calculation issue. So, we're allowing that to happen in our claim line item entry, and we'll pass that through to NDIS with an appendix to the invoice number of #P01 or #P02 (as many as you need) when you review that claim in PRODA or reference it in the Remittance advice from the NDIA. On the Planability claim, it will just appear as another line item in the same invoice claim.

      When you add a line that is a duplicate of an existing one, you will be warned with this pop-up:

      • Select the Support Category and the Item Name. 

      Tip: Copy the Item code from the invoice and paste into the Item Name field to display the Item, or enter the first group of 3 digits (053 in the example below).

      • The Service booking number will display, along with Remaining Available Budget for this category and any unavailable budget (due to pending claims or Service Agreements)


      • The Unit of Measure (eg., Hour) will show with price limit for this item.

      Select Service Booking 

      • If you are entering a claim for a stated item and there is more than one Service Booking (ie., one for the Stated Item and one for the Category, you will need to select the correct Service Booking. An * after the Service Booking number denotes that it is for a Stated Item:

      • Enter Quantity (ie., units of hours). Confirm that the Unit Price matches the Unit Price in the Invoice, and that the Total amount for this support category is correct as per the Invoice.
      • Check the GST status and Claim Type and update if required. 
      • Click 'Add' to finish entering this item.
      • Repeat this process for each different item until all items are entered.

      TIP: Use the Clone feature to quickly clone a claim line. The dates and Support Category will be cloned reducing the number of fields you need to complete.

       

      Review Claim and Submit Claim


      Check that the Invoice Total matches the total amount on the uploaded invoice. 
      • If there are any errors such as the totals do not match, you can edit or delete the Line Items by clicking on the three radial buttons to the right and making your selection.
      • When the claim is ready to be submitted. Click 'Confirm' at the top right of the screen.
      • You will then view the Claim Details. Edit if required, or Hold for Review. If the claim requires approval, click 'Request for Approval'. If no approval is required, submit to NDIS.
      • The Claim Details screen will now display showing the total amount claimed and it's status. Each Support Item will display showing the Claim Amount, the Pay Amount and the Claim Status. The Claim Number is a hyperlink to the claim in PRODA.

      Any warnings will display. Warnings such as the Pay Amount is different to the claimed amount, or Item Rejected.

      Show Timeline will display all stages of the claim

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