If you are wondering about the rejected NDIS claim, you are not alone. It is quite common to experience rejections when you are considering NDIS for the first time in life.
Now that you are looking for NDIS plan management in Sydney, you should first understand why NDIS claims receive rejections in the first place. Because it is highly likely to overlook important details in the process.
And this is where a reliable NDIS plan manager ensures to include essential information, reviews the necessary bank details, checks the validity, and verifies the claim with NDIS guidelines. In this blog, you will understand strong reasons behind rejected NDIS claims and the role of plan managers in full detail. So, keep reading it till the end.
Reasons Behind Rejected NDIS Claims
When you are self-managing your NDIS plan, it is possible to observe rejected NDIS claims. This delays the payment process and interrupts the service deliveries from NDIS registered providers.
Here are some of the most common reasons why your NDIS claim is facing rejections.
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Incomplete Information:
If you fail to include supporting documents in the digital NDIS claim form, the NDIA can disapprove your request. This happens when you are not providing enough reasons to the government to believe on two factors. One is whether you are actually receiving the claimed services and the other is if the services are progressing your growth.
You must request attendance sheets, time logs, and progress reports from your provider. As a matter of fact, you can also consider NDIS plan management in Sydney to submit a complete and accurate NDIS claim.
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Overbilling:
When service providers are invoicing for more than the agreed prices outlined in the service agreement, you do not get the funds.
This is possible when you fail to verify the invoice with the agreed price and extent of service. This error generally passes on to an NDIS provider for overbilling. But it is just as much your responsibility too.
In such cases, it is good to hire an NDIS plan manager. He double-checks the invoices according to the service agreement, asks relevant questions for any confusion, and ensures full compliance with NDIS price limits.
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Invalid Claims:
NDIA does not approve claims if your NDIS plan is no longer valid. That is to say, you must request claims before the expiry date of your plan to avoid any sort of a rejection.
However, if you have received services after the plan validity, you should wait until the approval of your new NDIS plan. It is only then that you can submit the claim and process payments.
The NDIS plan management in Sydney always ensures to request a plan review months before the current plan expiration date. This prevents payment delays to providers and ensures continuation of the service for participants.
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Making Duplicate Claims:
Duplicate claims happen when you unintentionally request payments for two similar services. Or, it is likely a case when two NDIS providers are submitting claims for the same service.
This problem arises the most when you fail to double-check the billing process, record the service name along with the provider’s information, and coordinate with multiple providers. As a matter of solution, it is best to consider an NDIS plan manager for tracking claims and requesting accurate invoices from providers.
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Misusing the Funding Category:
Some providers can submit claims under the wrong funding category than what is outlined in the NDIS plan. Many of them often confuse one service with another or misunderstand the funding category.
As a result, your claim can come across as unqualified for further processing due to the illusion of overspending. For example, if you choose higher budget services like assistive technology under a limited funding category like Core support, NDIA can reject your claim for overspending.
It is crucial to invest your time and effort into an NDIS plan management in Sydney for the most effective processing of claims.
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Services Not Covered by the NDIS Plan:
Claims for services which are not eligible for funding or do not fall under the right funding categories are a big mistake. This happens when you fail to double-check the services claimed, their duration, frequency, and their costs before submitting them.
It is therefore crucial to trust an NDIS fund manager to allocate services just in the right categories like Core Supports, Capacity Building, Capital. As a participant, seeking prior approval for certain services is also necessary.
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Missing Service Agreements:
If the service agreement is missing or looks incomplete, the NDIA has the power to fail your claim on the grounds of informal agreement.
This is most likely a concern when there is an error in the portal. On some occasions, unsigned agreements also cause major trouble. The best way to prevent any of these likely causes is to seek assistance from an NDIS plan management in Sydney for internal checks and accurate verification of the required documents.
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Incorrect or Incomplete Service Codes & Billing Information:
NDIS claims require correct service codes and rates. If service providers use outdated, incorrect, or generic codes that don’t match the services, the claim gets rejected.
This often happens when providers don’t stay updated with the latest NDIS pricing guides or fail to follow the specific service coding requirements. Similarly, incorrect billing information, such as the provider’s registration number also prevents the timely payment process.
To avoid this, it’s crucial to hire an NDIS plan manager who coordinates with providers to use the latest NDIS service codes and ensure accurate billing.
Final Words
We hope you found this blog useful and relevant. As you see, there are different concerns behind rejected NDIS claims. Remember, the goal is to take up services like NDIS plan management in Sydney for effective and timely payment processing and uninterrupted services.
We recommend consulting NDIS fund managers of Kencho Plan Management for their expertise, NDIS compliance, and diligence in NDIS plan management services. Contact the team today to learn more details.
