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.
This article includes guides on:
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!
The NDIS offers three ways for patients to manage their NDIS plan.
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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:
|
|
Plan-managed |
The NDIA provides an organisation (plan manager) with funding to pay the patient's healthcare providers on the patient's behalf |
Patient - c/o Plan Manager |
In the patient's NDIS claim:
|
|
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: |
To set up NDIS billing for your practice, you must have the following elements in place:
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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.
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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.
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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.
The setup for NDIS billing is similar to third party billing. Click the arrows below to go through the complete step-by-step instructions.
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Step 1: Set up the NDIS funder and import fees
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.
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Click Finances > Fees.
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On the top right, click New Fee.
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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.)
Image: Importing an NDIS fee from the Halaxy database includes the correct fee details
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Click the Funders tab.
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In the funder list, click National Disability Insurance Scheme (NDIS) to open the funder settings.
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In the NDIS funder settings, configure the following:
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Funder Type: This must be set to NDIS.
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Payer: Select who will be the default payer for invoices with NDIS fees. You can set a different default for individual patients.
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Patient: The patient pays for the invoice. (Recommended if majority of your NDIS patients are self-managed.)
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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.)
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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.)
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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.)
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Invoice Merging: Select your preference for which fees under this funder are allowed to be merged into an invoice.
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Same practitioner / same clinic: Allow merging only for fees by the same practitioner from the same location (default)
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Same practitioner / any clinic: Allow merging only for fees by the same practitioner from any location in your practice group
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Any practitioner / same clinic: Allow merging only for fees by any practitioner but from the same location
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Any practitioner / any clinic: Allow merging for fees by any practitioner from any location in your practice group
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Paying Organisation: The default organisation that is billed and receives the invoice.
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If majority of your NDIS patients are NDIA-managed, set this to National Disability Insurance Agency.
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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.
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Invoice Schedule: The frequency of collating invoices for the paying organisation. For example: Daily, Weekly, Monthly. See related article: Set up an invoice schedule
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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.
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Step 2: Set up individual patient NDIS claim details
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 number, the default invoice payer for their appointments, and (if required) the patient's name to be anonymised.
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Open the patient profile and click the Funding tab.
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At the top right, click New Claim and set Funder to National Disability Insurance Agency.
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In the form, configure the following:
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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.
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Self-managed patients: Leave this field blank.
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Plan-managed patients: Enter the name of the plan manager.
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NDIA-managed patients: Select National Disability Insurance Agency.
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Invoice Schedule / Payer: You have the option customise these fields for every patient, which overrides the default funder settings.
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Reference Number: Enter the patient's NDIS number for their plan.
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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.
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Click Next or Save.
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Add the referral/s to the patient's claim, where you can add the referral time and/or value limits.
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.
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Step 3: Set up paying organisation details
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.
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Click Contacts > Organisations.
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In the list, click the organisation to open their profile. (To add a new organisation, click Add Organisation in the top right.)
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To edit the organisation's details, click Edit, enter the required information. (Tip: To ensure successful billing, it's recommended to add the organisation's ABN and address.)
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If the NDIS participant is plan managed, the organisation Type must be set to Plan Manager.
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Click Save.
You have successfully completed NDIS setup, you are now ready to create appointments with NDIS fees, and the invoices are automatically created and configured with the correct details for you.
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Step 4: Application
Now that you have completed setup, NDIS billing is automatically done for you just by creating an appointment. Whenever you add a new NDIS patient, make sure to set up their NDIS claim details by following this setup process.
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Open the calendar.
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Create an appointment for the participant with an NDIS fee.
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Click Invoice to open the appointment invoice.
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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.)
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This invoice is now ready to be submitted for claims processing:
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For NDIA-managed claims: If you have connected your HICAPS Digital Claims account to Halaxy, can click Process NDIS straight from the invoice.
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For plan-managed and self-managed claims: Click the
paper plane icon to send this invoice to the plan manager or patient.
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Note
For plan managed participants, their Halaxy invoice may appear to be billed to the plan manager. When you print or email the invoice, the invoice will show that it is billed to the patient and in c/o (care of) the plan manager.
Tip
If you need to display the item quantity or pro rata rate on the invoice, you can set these to show in your invoice template preferences.
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If you want to keep track of your patients' NDIS plans, you have the option to add plan details to a patient's claim, such as start date, end date, budget, and funding periods.
For patients with funding for multiple kinds of NDIS supports, you can use referral types to create support category templates, which automatically apply the correct support funding to appointments for you.
Click the arrows below to go through the complete step-by-step instructions.
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Overview
This is an example of how you can keep track of a patient's NDIS support categories and their funding periods and budgets in a patient's claim.
Area
Information
Plan overview (blue)
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Reference Number (NDIS number)
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Paying organisation
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Plan description or notes
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Plan date range and total funding amount
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Templates for support categories, their funding periods and standard funding amount per period
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Total usage vs total funding amount per support category
Plan overview details are only displayed in the patient profile funding page. They cannot be viewed or generated from appointments, notes, invoice or reports.
Funding periods (pink)
Details for the funding periods in use for each support category:
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Start and expiry dates
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Support category name
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Limit for allocated time (e.g. number of appointments, hours)
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Actual usage vs total funding period budget
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Projected usage vs total funding period budget (includes charges from booked future appointments)
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Actions for each funding period:
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Roll over balance to new funding period
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Edit funding period details
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Delete funding period
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Funding period details are displayed in your calendar appointments where they are applied.
Tip
If the patient's NDIS claim has an existing plan with amounts included OR if the patient starts a new plan, archive the claim first (
bin icon) so that past funding periods will not be included in the Total Usage.
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Step 1: Import fees and set up support category
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Import your NDIS fees as shown in the section above.
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Create a referral type for an NDIS support category with its corresponding funding period length, and link the fees to group under it. Whenever these fees are added to an appointment, the support category's funding period is automatically applied.
Example of a support category template set up as a referral type with linked fees (click to expand)
Note: If the funding limits (e.g. number of sessions, monetary allocation) are different per patient, leave these fields blank. These can be set individually per patient.
Important
Make sure to set NDIS as the funder for the referral type.
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Step 2: Set up the patient's NDIS claim and plan details
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In the patient profile funding tab, create an NDIS claim for the patient, as outlined in Step 2 in the the previous section. (This step is automatic when a patient is booked for an appointment with an NDIS fee.)
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After creating the NDIS claim, click Add Plan Settings.
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In the pop-up, configure the following:
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Under Plan Settings:
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Plan Start Date / Plan End Date: Enter the plan start and end date.
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Plan Total Funding: Enter the total value allocated for the plan for the start and end date.
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Under Support Categories:
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Click Add Support Category to add a new support category template (i.e. the referral types you created) that will be used in this plan. enter the referral types (support category templates) / funding periods used in this plan.
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For each support category, enter the number of periods and the amount per period budgeted in this patient's plan.
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Additional Notes (optional): Enter a short description for this plan to provide context.
Note: The information added in this pop-up is purely for reference purposes and must be manually updated when you add new support category funding to the claim.
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Click Save.
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Step 3: Add the funding periods
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Under the patient's NDIS claim, click Add Funding Period.
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In the pop-up, configure the following:
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Referral Type: Select a support category template included in the patient's plan.
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Date / Expiry Date: Enter the start date for this referral. This automatically populates the expiry date based on the funding period duration you sent in the support category template.
IMPORTANT: You must set the start and expiry dates so that Halaxy automatically applies the correct support category and funding to appointments that fall within this date range. If you leave these blank, this funding period will be applied indefinitely to appointments with this support category's linked fees.
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AUD Limit / Limit: Enter the funding amount or time allocated for this funding period in this patient's plan. (You can refer to their plan details for this information.)
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For a complete guide to other fields in this pop-up, see this article: Guide to referrals
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Click Save.
You are now tracking this patient's NDIS plan and funding periods.
Example of tracking a patient's NDIS plan and funding periods in use
An example of patient funding information displayed in an appointment
Note
When reaching the end of a support category funding period, click the
copy icon to create a new funding period with any unused balance rolled over.
Tip
Want to know when your patients' funding periods are expiring? You can enable an in-app notification to alert you, or set up a campaign to automatically alert patients.
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By entering the schedule of your services for a patient's current NDIS plan, you can then create personalised service agreements for patients using the dynamic term that populates the schedule.
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Open the patient profile and click the Funding tab.
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Under the patient's NDIS claim, click Edit Schedule of Services.
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In the pop-up, enter the fee/s for the service/s you will be providing to the patient under their current NDIS plan.
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Click Save.
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Create a service agreement template, then insert the dynamic term [Current Schedule of Service] within the editor.
You can now send this service agreement to your patients via patient forms. When the patient opens the agreement, the schedule of services for their plan will be populated with the correct information.
Example of a patient form containing the schedule of services personalised to the participant
Preset travel fees for NDIS are labelled for two categories:
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Labour travel costs
Labour travel cost is the time spent by NDIS providers travelling to—and sometimes from—a participant. Providers can claim a maximum of 30 minutes travel time for MMM 1-3 areas, or 60 minutes for MMM 4-5, per way.
To import a preset labour travel fee, type the service fee name or item number with "National: Provider travel - labour costs".
Labour travel fees are always half the price of an hour's cost of the service fee, and can be calculated depending on the fee type you want to use:
Example 1. Item fee type to calculate price based on the quantity of time increments
In this example, you can add all fees in the same appointment.
Fee
Duration (mins)
Cost per 60 mins
Quantity
Price
Service
180 mins
$50
3
$150
Travel to
15 minutes
$25
0.25
$6.25
Travel from
15 minutes
$25
0.25
$6.25
Note: Item quantity only allows up to 2 decimal places and will always round to 2 decimal places. If you would like more accurate calculations, use the pro rata fee type.
Example 2. Pro rata fee type to calculate price based on appointment duration
In this example, each fee is in its own appointment to calculate the price on their separate durations. You can then merge the invoices into one.
Fee
Duration (mins)
Cost per 60 mins
Pro Rata
Price
Service
180 minutes
$50
50*3$150
Travel to
10 minutes
$25
25*(10/60)$4.17
Travel from
10 minutes
$25
25*(10/60)$4.17
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Non-labour travel costs
Non-labour travel costs are expenses incurred by NDIS providers when travelling to deliver support services, excluding the cost of the support worker's time. These expenses must be agreed upon with the participant beforehand. Examples: tolls, parking fees, vehicle depreciation.
Examples of non-labour travel costs include:
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Tolls
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Parking fees
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Public transport fares
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Running costs of a vehicle
To import a preset labour travel fee, type the service fee name or item number with "Provider travel - non-labour costs".
Tip
Set up non-labour travel fees as an Item fee type, not Pro Rata.
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