Sometimes an invoice submitted to your plan manager can’t be paid because of NDIS rules or funding requirements. We know this can be confusing and frustrating, so this guide explains what’s happening, why and how you can move forward.
Why an invoice may not be payable
Under the NDIS legislation, plan managers must follow strict rules about how NDIS funds can be used. We can only pay for supports that are listed as funded NDIS supports, are aligned with what is written in your NDIS plan and comply with NDIS Pricing Arrangements and Price Limits.
The NDIA also publishes a list of supports that are not NDIS supports, which cannot be claimed unless you have specific written approval from an NDIS Planner.
If the invoice includes a support that is on the non-fundable list, your plan manager is legally required to decline the claim, even if the support feels helpful or important to you. If MyIntegra is your plan manager, we can review the invoice with you and work with you to understand what is being claimed, the reasoning for the outcome and your options.
Situations where a non-fundable support might still be paid
There are a few exceptions that would allow your plan manager to process a claim for a support that is normally non-fundable.
Your invoice may still be claimable if one of the following applies:
1. The support is listed as a stated support in your NDIS plan.
2. You have a NDIA approval letter confirming the support can be claimed as a replacement support
3. You have written approval from the Administrative Review Tribunal (ART) confirming the support can be claimed
4. You have written approval from an an NDIS Planner confirming the support can be claimed
If you have any of these documents submit them to your plan manager so the invoice can be reviewed again.
What to do if you don’t have the required approvals
You still have options. Here are the next steps you can take:
1. Contact the NDIA directly
Call 1800 800 110 to speak with the NDIA about
- Why the support may not be fundable
- Whether you can apply for a replacement support
- What documentation might be needed
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The NDIA has a dedicated team for questions about funding rules.
2. Apply for a replacement support
Replacement supports may be available when a participant has funding for a support that has been changed or removed from the NDIS supports list.
Visit the NDIS website to learn
- What a replacement support is
- Who can apply
- What evidence you need
- How to submit your application
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3. Speak with your LAC, Support Coordinator or NDIS Planner
Your LAC, Support Coordinator (if you have one) or NDIS Planner can help you:
- Understand why the support wasn’t fundable
- Identify alternative funded supports that match your goals
- Prepare an application to the NDIA for a replacement support or apply for an ART
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4. Speak to your provider
You may also want to contact your provider to let them know the support is not currently fundable under NDIS rules. They may be able to suggest a similar support they can provide that is fundable or provide supporting information for a replacement support request.
If you believe a decision is incorrect
Plan managers are required by law to follow the NDIS rules and supports lists. However, mistakes can happen, or details can be misunderstood.
If you believe an invoice has been incorrectly declined, contact your plan manager to review the details.
If MyIntegra is your plan manager, we’ll happily review the invoice with you, explain the reasoning and help you understand your options. You voice matters and we are here to support you.
How MyIntegra can help
We’re here to help you get the most value from your plan and navigate the NDIS. We can support you with:
- Explaining why a support is and isn’t fundable
- Reviewing invoices with you
- Checking if an approval might be possible based on your documentation
- Providing information to your LAC, Support Coordinator, Provider or NDIS Planner
- Understanding your options and next steps
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You can contact our team if you have any questions or want to talk through your situation. We’re here to support you every step of the way.
Interested in switching to MyIntegra for plan management? Contact us today to see how we can help you make the most of your NDIS plan
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