The NDIS framework includes various rules for claiming support items, depending on whether they are subject to quotation, have a price limit, or do not have a price limit. Understanding these distinctions is crucial for both providers and participants to ensure proper billing and compliance.
Claiming for Support Items that are Subject to Quotation
Providers can only claim for a support item that is subject to quotation from a participant’s plan if they provided a quotation to the NDIA for the support item and it is a stated item in the participant’s plan. When the NDIA approves a quote, it will create a service booking for the support item that the provider can use for claiming purposes.
This process ensures that both parties agree on the cost and specifics of the service beforehand, leading to more accurate and transparent billing.
Claiming for Support Items that Have a Price Limit
Where a support item has a price limit, the provider cannot agree on a price for the support with the participant that is greater than the price limit. Claims should be made in the units specified for the item and at the agreed unit price, which must not be higher than the applicable price limit.
For example, if a provider has agreed to deliver a support to a participant at an hourly rate of $50 and provides support for 30 minutes, they should make a claim for 0.5 hours at the agreed unit price of $50. They should not claim for 1 unit at $25. This ensures that billing remains consistent with the agreed terms and avoids overcharging.
Claiming for Support Items that Do Not Have a Price Limit
Where a support item does not have a price limit, the provider and participant should agree on the reasonable price for the support. If necessary, they should also agree on the billing schedule for the support. For example, they might agree that a support should be claimed weekly. These claims are subject to the general claiming rules, including that supports can only be claimed for after they have been delivered.
Providers should claim for that item by reference to the “notional unit price” if there is one set out in the NDIS Support Catalogue or the NDIS Assistive Technology, Home Modifications and Consumables Code Guide.
For instance:
- Example – Claiming for Low Cost AT: A provider has agreed to deliver a text player to a participant at a cost of $530. The relevant support item (03_220300911_0113_1_1: Low Cost AT for Vision Related AT) is not subject to a price limit but has a “notional” unit price of $1.00. The provider would submit a payment request for 530 units at $1.00 a unit for a total amount of $530.
- Example – Claiming for Activity-Based Transport: Activity-based transport support items are not subject to price limits but have a “notional” unit limit of $1.00. If the non-labour costs of the activity-based transport was $21.50 (as in the example support item 04_590_0125_6_1), the provider would submit a payment request for 21.5 units at $1.00 a unit for a total cost of $21.50.
Ensuring Compliance and Integrity
At Trusted Care & Support Services, we are dedicated to following these guidelines meticulously to ensure compliance and maintain the trust of our participants. Accurate claims and transparent service agreements form the backbone of a reliable and ethical service delivery framework. Our commitment to these principles ensures that participants receive the best possible care while maintaining the integrity of the support system.
By understanding and adhering to the NDIS claiming rules and service agreement guidelines, both providers and participants can work together to create a supportive and transparent environment. This approach not only enhances the quality of care but also fosters a stronger, more trusting relationship between providers and participants.
If you have any further questions about our claiming processes or service agreements, please do not hesitate to contact us. Trusted Care & Support Services is here to help you navigate the complexities of the NDIS and ensure you receive the support you need in the most transparent and effective manner.