NDIS PACE for providers.

How will a participant being on PACE affect your processes as a provider?

The simple answer is –  it won’t.

If the participant you are providing services for is plan managed or self managed, nothing significant will change. If your participant is plan managed by Leap in!, please send your invoices as usual and we will process them.

If the participant you are providing services to is Agency managed, they are now required to endorse the providers they want to work with in order to access funding for relevant services. You can find more details on provider endorsements in part 2 of this series.

It is plan managers and support coordinators who see the largest direct impact on their processes.

The NDIS website has more details on the PACE roll-out and expected timeframes.

Longer NDIS provider payment times.

To strengthen the NDIS by reducing fraud and non-compliant behaviour, the NDIA has announced some changes to the claims review process.

The NDIS is now conducting more thorough reviews of claims before releasing funds, meaning longer turnaround times for provider payments and reimbursement. This will extend payment timeframes by a minimum of 24 hours on top of existing payment turnaround times.

Overnight releases of funds by the NDIS will no longer occur.

Valid reimbursements and payments to providers will be processed within 2 to 3 business days from the submission date to the NDIS. For more complex claims that require additional checks, payments made by the NDIA may take up to 10 days.

Please note: The Leap in! team processes your payments and reimbursements as soon as we receive them from the NDIS. It is the new NDIS claims review process that is adding to payment timeframes.

Changes to support categories.

On PACE there are a few notable changes to how plans are structured. There are no changes to support item descriptions, or the numbers providers use to make claims.

Support categories are divided into four support types on PACE:

• Core
• Capacity building
• Capital
• Recurring (new).
• The Recurring budget category is for supports that a participant receives directly from the NDIS on a regular basis.

See our dedicated page on PACE support categories for more details.

My NDIS provider portal.

Providers will need to use the new my NDIS provider portal when working with a participant with a PACE plan.

The new my NDIS provider portal is different to the myplace provider portal. Before providers can see participant information in the my NDIS provider portal, participants will be asked for their consent.

Note: If you’re a support coordinator or a psychosocial recovery coach you will need to be registered with the NDIS Quality and Safeguards Commission, have a Provider Digital Access (PRODA) account and register your details with the NDIS to gain access to the my NDIS provider portal.

Provider endorsement for my NDIS.

As a provider it is important for you to know how your clients manage their NDIS Plans and, if required, be added as a “participant-endorsed provider” under “My providers” in the PACE system.

The process for a participant to endorse you as a provider is simple. The participant can contact the NDIS national call centre or their local area coordinator to advise that they would like to endorse you as a provider.

• Agency managed participants: are required to endorse the providers they want to work with in order to access funding for relevant services.
• Plan managed participants: have the option to endorse their providers if they choose. The only provider that must endorse is their plan manager, so they will be able to claim invoices against a participant’s plan.
• Self managed participants: have the option to record providers for their supports under “My providers” however it is not required.

The endorsement does not apply to every person in your organisation. You will need to nominate one or more staff members as a “person with consent” to act on behalf of the participant.

Note: If you provide SDA, home and living supports (including SIL), or behaviour supports you must be recorded as a provider in the participant’s NDIS Plan under “My providers” regardless of how the plan is managed. Failure to do so may result in automatic claim rejections.

PACE plans and participant consent.

PACE introduces enhanced consent mechanisms, allowing participants to grant providers access to specific parts of their plan, including budget information, goals and funded supports, rather than the entire document.

This empowers participants to control how their personal information is shared while ensuring you, as the provider, have the information needed to deliver the necessary support.

For participants and providers it is now even more important to have written service agreements in place. These agreements serve as a roadmap, outlining funding allocations and expectations for clarity and accountability.

Use bulk upload for claims on PACE.

As participants transition to PACE, providers will no longer have access to the single line-item claim function within the myplace provider portal. Instead, claims for PACE participants must be submitted via bulk upload. This new approach is designed to reduce the number of transactions providers need to make.

The bulk upload allows providers to submit multiple claims, or a single claim, in one transaction. To do this, you will need to use the bulk payment request template, which can be accessed and submitted through the myplace portal.

You can use the bulk payment request template for participants who are on the PACE system and those who are not. All claims are processed through the myplace provider portal. The service and support details required for claims on PACE are the same as those currently in use.