NDIA PAUSE PRE-PAYMENT REVIEWS AFTER DIA INTERVENTION
DIA’s has intervened after it came to our attention that several members have received correspondence from the NDIA, specifically from the Claims and Payment Integrity Section (C&PI), that they had been “selected” as part of a pre-payment review process.
The correspondence detailed that selected providers who had submitted payment requests (PRs) would be subjected to a pre-payment review that would automatically “lock” those requests for five (5) business days after which the payment would either be made or rejected if deemed non-compliant.
After being alerted to the Agency’s actions by several members, DIA contacted the NDIA to seek clarification of the compliance activity as no prior notification had been given that this program was to be put in place. Whilst DIA do not disagree with the general concept of pre-payment audits, without consultating with the sector the practical implications for Plan Managers was not been fully appreciated by the NDIA.
In representing affected Members DIA highlighted that the NDIA were prepared to “lock” payments for five (5) business days to conduct these reviews but in their own Guidelines expect RPMPs to validate and process invoices in two (2) business days. DIA suggested to the NDIA that if the expectation of RPMPs is to ensure that invoices are validated in two (2) business days then surely this standard should also apply to the NDIA.
DIA understands that this program was paused late on Thursday night and as such should not impact claims made from 9am Friday 19th. Plan Managers may have received emails upto COB Friday 19th notifying that their claims have been included in the program / locked etc however this should be for claims submitted up until Thursday 18th.
If any member believes that any claim made from 9am Friday 19th has been included in this program please email firstname.lastname@example.org with the details of such claims and we will escalate to the NDIA for speedy resolution.
DIA will continue to pursue this matter during this pause to ensure that any such program is fit for purpose.
Below is a statement from the NDIA on this matter.
The National Disability Insurance Agency (NDIA) is responsible for protecting the National Disability Insurance Scheme (NDIS) from fraudulent and non-compliant behaviour that results in the misuse of participant funding.
The NDIA recently ran a pilot of a compliance exercise targeted at reducing claims and payments errors through the development of new system and process controls to contribute to improving provider, plan manager and participant claiming behaviours.
During the pilot, payments to a small number of Registered NDIS Providers and Plan Managers were reviewed and checked to ensure their claims are in line with current NDIS pricing arrangements.
Once claims were assessed they were either released for payment, or if they were deemed as non-compliant, they were cancelled. If a claim was cancelled, providers and plan managers were provided with a record of the cancelled payment request and additional information and resources to support them to submit compliant claims.
The pilot is part of a broader program of work to ensure:
- participants are getting the right support, at the right rate, when they need it
- claims are compliant (ideally) before the Agency releases funds to make a payment
We have received several enquiries regarding the impact of the pilot on remittance and disbursement processes for Registered NDIS Providers and Plan Managers. As a result, we have made the decision to pause the pilot.
This will provide the opportunity for consultation with the market to implement a process which does not create unnecessary administrative pressures on Registered NDIS Providers and Plan Managers.
Impact on processing times
During the pilot, the payment request status on the provider portal appeared as ‘pending payment’ for a longer period than normal. It will stay this way for up to five days. During the pilot all claims from Plan Managers were reviewed within 24 hours of submission and all compliant claims were released into the pay cycle on the following day.
Advice on how to deal with incorrect remittances
Following today’s close-out activities, the pilot will not continue until a resolution for the remittance issue is identified. If Registered NDIS Providers and Plan Managers have any remaining issues with previous remittances, they can contact email@example.com using the subject line: Query pre-payment remittance advice. Please include as much information as possible to support us to action the request.
DIA is a members-based organisation. We are only able to do the work that we do because of the ongoing support of our members. Thank you to all DIA members that continue to support the work we do. If your a provider delivering Support Coordination or Plan Management are not yet a member, you should consider joining.