Guide to National Disability Insurance Scheme (NDIS) billing

Invoices and claims for patients under the National Disability Insurance Scheme (NDIS) can be easily set up and managed through third party billing. With a proper setup in place, your invoices are always automatically billed to the correct parties - the patient, plan manager or the National Disability Insurance Agency (NDIA).

For added convenience, Halaxy also features an NDIS bulk upload report to review your NDIS claims. You can upload this report directly to PRODA.

Tip

Want to process NDIS claims in Halaxy? With our HICAPS Digital Claims integration, agency-managed NDIS claims can be processed straight from an invoice with one click of a button!

Overview

The NDIS offers three ways for patients to manage their NDIS plan.

Plan

Description

Who is billed

What to set in Halaxy

Self-managed

The NDIA provides the patient with funding to pay healthcare providers

Patient

In the patient's NDIS claim details:

  • Payer: Patient

Plan-managed

The NDIA provides an organisation (plan manager) with funding to pay the patient's healthcare providers on the patient's behalf

Plan Manager

In the patient's NDIS claim:

  • Payer: Organisation

  • Paying organisation: The plan manager

NDIA-managed (agency-managed)

The NDIA directly pays the patient's healthcare providers on the patient's behalf

NDIA

In the patient's NDIS claim:

  • Payer: Organisation

  • Paying organisation: NDIA

To set up NDIS billing for your practice, you must have the following elements in place:

  1. Set up the NDIS funder and fees: This configures the default settings for claims and billing for invoices with an NDIS fee. You only need to import and set up the funder and each fee once.

  2. Set up patient NDIS claim information: This automatically sets the patient's NDIS participant reference number and their default payer (see table above) in invoices.

  3. Set up paying organisation details: This automatically enters the organisation's address, business registration number and other details whenever they are billed in an invoice.

When you have followed the steps above, Halaxy automates the NDIS billing and claims process for you, no matter who pays the invoice.

Set up NDIS billing in Halaxy

The setup for NDIS billing is similar to third party billing. Select the tabs below for complete step-by-step instructions.

  • When you import an NDIS fee from Halaxy's preset database, you also import the NDIS funder. In this step, you are configuring the default settings for claims and billing to automatically put in place for invoices with an NDIS fee.

    1. Click Finances > Fees.

    2. On the top right, click New Fee.

    3. In Lookup, import an NDIS fee that you use in your practice. Configure the fee details and pricing, then click Save Fee. You can import more fees later. (For more details, see our guide on adding and importing fees.)

      NDIS-01.png

      Image: Importing an NDIS fee from the Halaxy database includes the correct fee details

    4. Click the Funders tab.

    5. In the funder list, click National Disability Insurance Scheme (NDIS) to open the funder settings.

    6. In the NDIS funder settings, configure the following:

      NDIS-02.png
      • Funder Type: This must be set to NDIS.

      • Payer: Select who will be the default payer for invoices with NDIS fees. You can set a different default for individual patients.

        • Patient: The patient pays for the invoice. (Recommended if majority of your NDIS patients are self-managed.)

        • Organisation (new invoice): The organisation pays for the invoice. A new invoice is created for every appointment booked with NDIS fees. (Recommended if majority of your NDIS patients are plan-managed or NDIA-managed.)

        • Organisation (existing invoice, same patient): The organisation pays for the invoice. All NDIS fees for this patient are grouped into a single invoice. The invoice is sent to the paying organisation according to the Invoice Schedule you set. (Recommended if majority of your NDIS patients are plan-managed or NDIA-managed.)

        • Organisation (existing invoice, any patient): The organisation pays for the invoice. All NDIS fees for all patients are grouped into a single invoice. The invoice is sent to the paying organisation according to the Invoice Schedule you set. (Recommended if majority of your NDIS patients are plan-managed or NDIA-managed.)

      • Invoice Merging: Select your preference for which fees under this funder are allowed to be merged into an invoice.

        • Same practitioner / same clinic: Allow merging only for fees by the same practitioner from the same location (default)

        • Same practitioner / any clinic: Allow merging only for fees by the same practitioner from any location in your practice group

        • Any practitioner / same clinic: Allow merging only for fees by any practitioner but from the same location

        • Any practitioner / any clinic: Allow merging for fees by any practitioner from any location in your practice group

      • Paying Organisation: The default organisation that is billed and receives the invoice. If majority of your NDIS patients are NDIA-managed, set this to National Disability Insurance Agency. If the paying organisation constantly changes, you can leave this field blank. You can assign an organisation in the invoice or patient's claim details.

      • Invoice Schedule: The frequency of when the paying organisation is invoiced. For example: Daily, Weekly, Monthly. See related article: Set up an invoice schedule

    7. Click Save.

    The NDIS funder and fees have been successfully set up.

    Whenever you use an NDIS fee in appointments, the generated invoice and financial reports are automatically set up according to the funder settings.

    Note

    If you create an appointment using an NDIS fee for a patient without NDIS claim details added, an NDIS claim is automatically created in their profile using the default funder settings.

  • Every patient booked for appointments with NDIS fees, must have the appropriate NDIS claim information in their Funding page. The NDIS claim sets the patient's NDIS participant reference number, the default invoice payer for their appointments, and (if required) the patient's name to be anonymised.

    1. Open the patient profile and click the Funding tab.

    2. At the top right, click New Claim and set Funder to National Disability Insurance Agency. (If the patient already has an NDIS claim, click Update claim details.)

    3. In the form, configure the following:

      NDIS-03.png
      • Paying Organisation: Enter the name of the organisation that is billed and receives the invoice. If it is a new organisation, select to add it to your organisations list.

        • Self-managed patients: Leave this field blank.

        • Plan-managed patients: Enter the name of the plan manager.

        • NDIA-managed patients: Select National Disability Insurance Agency.

      • Invoice Schedule / Payer: You have the option customise these fields for every patient, which overrides the default funder settings.

      • Reference Number (optional): Enter the patient's NDIS participant reference number.

      • Anonymise patient details on invoice (optional): Tick the checkbox to hide the patient's name on the invoice to appear in the format HK 123456.

    4. Click Next or Save.

    Whenever you book this patient for an appointment with an NDIS fee, the invoice is billed according to the patient's NDIS claim details.

    Individual patient claim settings override the default funder settings, which means each patient can be assigned their own paying organisation.

    Note

    Does your patient have multiple plan managers? Set up multiple claims for them, with each claim billed to a different default paying organisation. You can switch between plan managers by selecting the correct claim on the invoice.

    Tip

    For one-off changes, you can change the payer or paying organisation in individual invoices.

  • The last step is to add the paying organisation's information so their details appear on the invoice. If provided, you can also add the organisation's payment details for automatic payment processing.

    1. Click Contacts > Organisations.

    2. In the list, click the organisation to open their profile. (To add a new organisation, click Add Organisation in the top right.)

    3. To edit the organisation's details, click Edit, enter the required information, then click Save. (Tip: To ensure successful billing, it's recommended to add the organisation's ABN and address.)

      NDIS-04.png
  • After setting up NDIS billing for your practice, you can now create appointments (with NDIS fees), and the invoices are automatically created with the correct information for you. Whenever you add a new NDIS patient, make sure to set up their NDIS claim details.

    1. Open the calendar.

    2. Create an appointment for your NDIS patient with an NDIS fee.

    3. Click Invoice to open the appointment invoice.

    4. If your patient has their NDIS claim details set up (from Step 2), the invoice is automatically billed to their specified default payer. (If the patient has no NDIS claim details, the invoice is billed according to the default settings for the NDIS funder.)

      NDIS-05.png

Updated

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