National Disability Insurance Scheme (NDIS) Billing

Halaxy

05 March 2020 06:28

Halaxy lets you process agency-managed NDIS claims directly from your invoices using our integration with LanternPay. This turns claiming into a single click, with payment usually made the next business day and your invoices automatically updated once payment is made, saving you the trouble of manual reconciliation. For more information, see our LanternPay article.

Halaxy also lets you easily manage NDIS invoices through third-party billing. If you have third-party billing correctly set up, Halaxy will automatically invoice the patient, the plan manager or the National Disability Insurance Agency (NDIA) whenever you use an NDIS fee for an appointment.

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

How to manage NDIS claims in Halaxy

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

Plan	Description	Who you bill	How to set it up in Halaxy
Self-managed	The NDIA provides the patient with funding so they can self-manage their plan	Patient	In the patient's NDIS claim, set the payer to "Patient"
Plan-managed	The NDIA pays an organisation called a plan manager, who pays the patient's healthcare providers on the patient's behalf	Plan Manager	In the patient's NDIS claim, set the payer to "Organisation" and set the paying organisation to the plan manager
NDIA-managed (agency-managed)	The NDIA pays the patient's healthcare providers on the patient's behalf	NDIA	In the patient's NDIS claim, set the payer to "Organisation" and set the paying organisation to the NDIA

When you import an NDIS fee from Halaxy's database, the NDIS is automatically set up as a third-party funder, but you can change who is billed by default in the patient's claim. This allows you to use the same fees from your Fees List no matter who is paying the invoice.

In each patient's Funding page, you can set up their individual NDIS claims to bill either the patient, a plan manager, or the NDIA. Halaxy will remember the settings for each patient's claim and automatically create the invoice accordingly whenever you create an appointment using an NDIS fee.

You can also set up default options at the NDIS funder level. If a patient does not have an NDIS claim set up in Halaxy when you add them to an appointment with an NDIS fee, a claim will automatically be created for them using the default options you have set up at the funder level.

Setting up your default NDIS settings at the funder level

When you import an NDIS fee from Halaxy's database, the NDIS is automatically set up as a third-party funder in your Funders tab (click Finances > Fees, then click the Funders tab).

The settings you configure for the NDIS at the funder level are used as default settings whenever a patient does not already have an NDIS claim set up (an NDIS claim will be created for the patient using the default settings when you add the patient to an appointment with an NDIS fee).

To set up the default funder settings for the NDIS:

Click Finances > Fees, then click the Funders tab.
From the funders list, click "National Disability Insurance Scheme (NDIS)" (if the NDIS does not appear in the list, you have not yet imported an NDIS fee. You can either import a fee or click Add Funder to add the NDIS as a funder). The Edit Funder screen appears:
Ensure that the Funder Type field is set to "NDIS".
In the Payment Details section, set up your default options:
- Payer - Choose from the following options:
  - Patient: By default, the patient will be billed whenever you use an NDIS fee. Suitable if the majority of your patients are self-managed.
  - Organisation (new invoice): By default, the organisation listed in the Paying Organisation field will be billed whenever you use an NDIS fee, with a new invoice created for each service. Suitable if the majority of your patients are plan-managed or NDIA-managed.
  - Organisation (existing invoice, same patient): By default, the organisation listed in the Paying Organisation field will be billed whenever you use an NDIS fee, with all services for a specific patient collated onto a single invoice. Suitable if the majority of your patients are plan-managed or NDIA-managed.
  - Organisation (existing invoice, all patients): By default, the organisation listed in the Paying Organisation field will be billed whenever you use an NDIS fee, with all services for all your patients collated onto a single invoice. Suitable if the majority of your patients are plan-managed or NDIA-managed.
- Paying Organisation: The organisation that will be billed by default. If the majority of your patients are NDIA-managed, enter the National Disability Insurance Agency. Otherwise, leave blank - you will be able to assign an organisation from the invoice itself or from the patient's claim details (suitable for plan-managed patients where you do not yet know who the plan manager is).
- Invoice Schedule: Set how often the organisation is invoiced. For example, if you wish to send the organisation a weekly collated invoice, type "Weekly" and select it from the drop-down menu.
Click Save.

RESULT: Whenever you create an appointment using an NDIS fee and the patient's NDIS claim details have not been set up, an NDIS claim using these settings is automatically created for the patient and used on the invoice.

How to set up individual patients' NDIS claims

An individual patient's NDIS claim settings specify the patient's NDIS participant reference number, who will be billed on the invoice (patient, plan manager or the NDIA) and whether or not the patient's details are anonymised on the invoice.

When you add a patient to an appointment that has an NDIS fee, Halaxy will automatically use the patient's claim details to determine who to bill on the invoice. This overrides the default settings at the funder level.

To create or edit a patient's NDIS claim:

Click the patient's name from your patient list or from an invoice or appointment.
Click the Funding tab.
In the Claim & Referrals section, click the Expand (+) icon to view the patient's NDIS claim, then click the Edit icon to edit the claim. If the patient does not have an NDIS claim, click New Claim at the top-right of the page and select the National Disability Insurance Scheme (NDIS) as the funder.
You will be prompted to enter details for the patient's claim. Complete the fields as follows:
- Paying Organisation: Set the organisation that will be billed on the invoice.
  - For self-managed patients, leave blank.
  - For plan-managed patients, enter the patient's plan manager.
  - For NDIA-managed patients, enter "National Disability Insurance Agency".
- Schedule: Set how often the paying organisation is billed. For example, if you wish to send a weekly invoice to the organisation, type "Weekly" and select it from the drop-down menu.
- Reference Number: Enter the patient's NDIS participant reference number. If you wish the patient details to be anonymised on the invoice, tick the checkbox marked "Anonymise patient details on invoice".
- Payer: Select the payer. For self-managed patients, the payer should be set to "Patient". For plan-managed patients or NDIA-managed patients, the payer should be set to Organisation. You have the following options for organisations:
  - Organisation (new invoice): A new invoice billed to the paying organisation is created for each service for this patient.
  - Organisation (existing invoice, same patient): Each service for this patient is added to a collated invoice billed to the paying organisation. The invoice contains all the services for this specific patient.
  - Organisation (existing invoice, all patients): Each service for this patient is added to a collated invoice billed to the paying organisation. The invoice contains all the services for all of your patients managed by this organisation.
Click Submit.

RESULT: Whenever you add the patient and an NDIS fee to an appointment, an invoice will be created according to the patient's NDIS claim details and billed to the correct payer. This overrides the default settings at the funder level.

Adding organisation details

You can edit an organisation's details, such as email address and business address, by clicking on the name of the Organisation from the invoice.

You can also access your organisations list by clicking Contacts > Organisations.

How to change the payer on an invoice

On any third-party invoice, you can change the payer between the patient and the organisation set up in the patient's claim. If you need to change the paying organisation to a different organisation (see below), you must first change the paying organisation in the patient's claim.

Changing the payer between the patient and the organisation

To change the payer between the patient and the organisation:

From the invoice, click the cogwheel in the top-right of the invoice.
The Invoice Summary pop-up appears. Click the Payer field and change the payer:
Click Submit.

Changing the paying organisation to a different organisation

If an invoice is billed to the wrong organisation, ensure that the patient's NDIS claim is set up to bill the correct organisation (see Step 4 above). You can then reset the paying organisation on the invoice by following the steps below:

From the invoice, click the cogwheel in the top-right of the invoice.
The Invoice Summary pop-up appears. In the Payer field, change the payer from Organisation to Patient.
Click Submit.
Click the cogwheel again in the top-right of the invoice.
In the Payer field, change the payer back from Payer to Organisation.
Click Submit.

RESULT: The invoice should now be billed to the paying organisation set up in the patient's NDIS claim.

NOTE: If the patient is managed by multiple plan managers, you may wish to set up multiple NDIS claims, with each claim billed to a different paying organisation. This will allow you to choose between claims on an invoice, effectively allowing you to choose between different paying organisations.