A providers’ guide to key changes with PACE.

This is the second instalment in our PACE and changes to the NDIS series.

This story looks at:

• How will PACE change provider payment and reimbursement turnaround times?
• The new “my NDIS” provider portal
• What is a provider endorsement and do you need one?

How will PACE change provider payment and reimbursement turnaround times?

The NDIS has announced changes to the claims review process. This measure is designed to strengthen the NDIS by reducing fraud and non-compliant behaviour. 

The NDIS is now conducting more thorough reviews of claims before releasing funds, affecting the turnaround time for provider payments and reimbursement.

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, rather than the previous 24 hours.

For more complex claims, processing by the NDIS may take up to 10 days.

Please note that 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.

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.

“my NDIS” provider portal.

Along with PACE, the NDIS has introduced a new provider portal called “my NDIS”.

All providers who access the “myplace” provider portal will also be able to access the “my NDIS” provider portal, however only those working with participants with a PACE plan will need to use it.

Please note that from 6 May 2024, the NDIS has advised that providers should submit all payment enquiries (known as provider payments) in the “my NDIS” provider portal – regardless of whether their participants have a plan in PACE.

Before providers can see participant information in the “my NDIS” provider portal, participants will need to provide their consent.

The new “my NDIS” provider portal is different to the “myplace” provider portal.

It allows providers to:

• Select and switch between active organisations
• Review, accept and decline Request for service requests
• View participant details
• Review and submit your reporting requirement for Request for service
• View participant plan and budget, where a participant has given consent
• Plan managers can view the Provider roles for participant
• View organisation details
• View bank account details
• View employee details
• View the specialist disability accommodation (SDA) tab, where SDA providers can create and manage dwelling enrolments.

There are also new notifications from the “my NDIS” provider portal that will let providers know when they have a task to complete or when participant budget information has been updated.

Depending on the types of service and the consents in place, providers will receive notifications when:

• They have a new relationship with a participant (“My provider“)

• There is a change in end date of a relationship
• There is a new Request for service
• A new plan is approved, including a change to the reassessment date
• A budget has changed or a support category budget has been added or changed.

Please note that if you are a support coordinator or psychosocial recovery coach who is not registered with the NDIS Quality and Safeguards Commission, you will need to create a PRODA (Provider Digital Access) account and register your details with the Agency 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.

As always, if you have any questions the Leap in! Crew is only a phone call away on 1300 05 78 78 or email crew@leapin.com.au.

The third and final part unpacks changes to participant budgets and support categories. Read it now.