Why plan managers can’t just pay an invoice when it’s disputed

An NDIS participant has choice and control over how their NDIS funding is used. This includes the ability to question or dispute an invoice if they believe the support did not align with their expectations or service agreement.

In some cases, this can become a time‑consuming and complex process, with plan managers often asked to help support communication between the parties while the issue is being resolved.

Why do payment disputes happen?

A payment dispute is rarely as simple as a participant simply not wanting to pay their provider. More commonly, it reflects a concern that needs to be addressed. Some of the most common reasons include:

• Expectations about what the service included, were different from the service that was delivered.
• The quality of the service did not meet expectations.
• A purchased item was not considered fit for purpose.
• A breakdown in communication or trust.

In many situations, once the concern is resolved, the payment can be made.

What happens when payment is refused?

When a participant does not approve an invoice to be paid, the following steps usually occur:

1. The provider submits an invoice.
2. The participant advises they do not wish to pay the invoice.
3. If the participant is plan managed, the plan manager places the invoice on hold.
4. The provider and participant work together to resolve the concern.
5. Once resolved, the participant confirms approval and payment can proceed.

What can a plan manager do?

Plan managers can often be caught in the middle of these situations. While they aim to support all parties, there are boundaries to their role.

Plan managers can:

• Review invoice details for accuracy and compliance.
• Help clarify information where needed.
• Support communication between participants and providers.
• Hold invoices while a concern is being resolved.

Plan managers can’t:

• Decide who is right or wrong.
• Enforce payment.
• Override a participant’s decision.
• Act as a formal mediator.

What should a provider do when a payment is refused?

When an invoice is disputed, providers should consider the following steps:

1. Speak with the participant – often there has been a miscommunication and once this is resolved, the invoice can be approved for submission to the NDIS for payment.
2. Review the service agreement – clarify what was agreed to, how expectations were set and whether the invoice aligns with this.
3. Provide supporting information – this can help to clarify what was delivered and when, for example progress notes, timesheets, communication records.
4. Consider partial resolution – in some cases, part of the invoice may be undisputed and able to be paid while discussions continue.
5. Escalate if required – if the matter cannot be resolved, options may include raising it with the NDIA, following a formal complaints process, or seeking independent advice

It is important to note that there is no formal dispute resolution pathway for most payment disagreements. When escalated to the NDIA, parties are often referred to each other to resolve the issue.

Preventing payment disputes

While disputes cannot always be avoided, there are steps providers can take to reduce the likelihood of them occurring:

• Use clear, plain-English service agreements.
• Set expectations upfront.
• Maintain open and transparent communication with participants.
• Ensure accurate and timely invoicing.
• Keep thorough records of services delivered.

What should a participant do if they’re unhappy with a service?

NDIS participants have the right to raise concerns about the supports they receive. Addressing issues early often leads to the best outcomes.
If a participant is not satisfied with a service, they should consider:

1. Speaking to their provider – many issues can be resolved with open communication.
2. Reviewing the service agreement – checking exactly what was agreed to and whether the service aligned.
3. Providing clear feedback to the provider about the concern – for example, the service did not meet expectations.
4. Letting their plan manager know, if their NDIS plan is plan managed – the plan manager can place the invoice on hold while the issue is addressed.
5. Escalating if needed by:
   • Following the provider complaints process
   • Contacting the NDIS Commission for concerns about service quality or safety.
   • Seeking independent advice or advocacy

Need support?

Although plan managers like MyIntegra cannot decide dispute outcomes, they can guide participants and providers on using NDIS funding, processing invoices for payment and provide guidance on what to do if a dispute arises.

For questions, participants and providers can contact the friendly MyIntegra Plan Management team on 1800 696 347 or email [email protected].