NDIS Invoicing: Why aren’t you getting paid?

The NDIS has cracked down on compliance and claiming and invoicing is in the firing line. 

Are you struggling to have your invoices paid by plan managers? Getting push back on services, or specific codes or line items on your invoices? Being asked for supporting documentation that you’ve never had to provide before? You’re not alone! 

So, what are some of the biggest mistakes we see providers making that are stopping them from getting paid? And what should you do to avoid those traps? 

1. The most fundamental issue: Do your services align with a participants plan?

The NDIS places the participant first. What this means is that all supports provided to a participant should be ‘reasonable and necessary’, be disability supports and also align with the goals and objectives of a participants plan. These goals may be very specific, for instance, a participant may have a goal (and related funding) to increase their capacity by undertaking training to allow them to take public transport on their own, or very broad – such as increasing their social and community participation. 

Whatever the goal is, your services must clearly meet at least one goal in a participants plan, and demonstrate how your services are helping the participant to achieve their goals in order to be funded.

2.  Are your services Disability Supports? 

The NDIS has introduced a specific list of disability supports (and what is not a disability support) which provides a comprehensive list of services which are considered disability supports.  

We have observed providers using any code which may apply for the support or “retrofitting” supports to a code where the participant has funding.  This can no longer continue.

Supports provided must align with the definitions of a disability support and comply with the NDIS rules, operational guidelines, and meet the participant’s plan and goals.  Service descriptions and language must be framed accordingly and codes applied to the specific services correctly.  Some services may no longer comply with the definitions of disability supports, and some services may require redesign to be eligible as a disability support. 

3. Item Codes – are you using the right code for your service?

The NDIS has a complex system of codes which relate to specific supports, and the additional services which can be legitimately charged to the NDIS (such as non-face-to-face support and provider travel) but be aware, each specific service has it’s own list of related codes and services which you can charge, if you use the wrong code you will not get paid, as the invoice will be rejected. 

There are specific rules and limits to item codes that you also need to comply with. 

4. Mandatory evidence of support

In the Q2 2024-25 NDIS quarterly report, as a part of the ongoing Fraud Fusion Task Force (FFT) fraud and integrity improvements, the NDIS implemented significant changes to reduce the fraud risk for the scheme. This included mandatory evidence of support, which was implemented in conjunction with a new ‘integrity management system’ which brought in more rigorous reviews of current claims. This means that plan managers and providers must include appropriate evidence of the support provided (in line with the requirements as outlined in the ‘documentation by support type’ guide in the provider toolkit).

Depending on the service you are providing you may need to be submitting service agreement, case notes, rosters of care or support logs along with your invoices. Without this information you may struggle to have your invoices processed.

5. Tightening of NDIS support categories 

The NDIS has updated the guidance on the flexibility of funding use within support categories. As a part of this update they have tightened the definition of supports and the way in which plans are structured to include a new element to plans called ‘funding components’.

A funding component amount is designed to specify exact supports within a support budget, potentially limiting the types of supports available for participants. This means, if a core support budget has specific supports identified within the body of their plan the participant would only be able to use the funding in that budget for the named supports. This may take the form of either explicitly ‘stated’ items, or items with stated portions of budgets or hours of support within a larger bucket, but could also include named elements within a support budget.

For example, if your plan lists psychology and occupational therapy in the description then these may be considered funding components and spending would be restricted accordingly. 

If a plan includes funding components, and your services are not included, the claim may not be processed, or that the purchase of those supports may be considered non-compliant. 

These issues are creating additional financial risks and debtors for NDIS providers.  

So what can you do to reduce your risks and get paid for what you do? 

• Have a signed engagement letter which is compliant with the NDIS rules and funded according to the participant’s plan.
• Make sure your invoices are compliant and include the right codes and information (learn more about the specific requirements for NDIS invoicing here)
• Create a list of internal checks to validate that your supports are included in the participants plan, and that the budget is allocated to those supports.
• Ask for a copy of the plan (but be aware, participants are not required to share their plans with providers)
• Meet with your participant and have a comprehensive onboarding process to explain charges and connect with family and other providers such as their Support Coordinator and Plan Manager.
• Ask the participant to add you to their “my providers” list.
• Bill early and frequently and have internal checks and balances on delayed payments.

If you are dealing with the pain of delays or rejections for your NDIS invoicing and need assistance, contact our NDIS specialist team today who work closely with NDIS providers to help them navigate the complexities of the NDIS and review their service offerings with the NDIS guidelines on eligible supports. 

For more information 

For more information, reach out to your local RSM Adviser.