NDIS to move to real-time claims, support payments

The National Disability Insurance Agency is preparing to develop a solution that will bring real-time claims lodgement and payments to the National Disability Insurance Scheme for the first time.

With payment volumes continuing to increase as the scheme ramps up, the agency has issued a request for information for a solution that allows participants and providers to lodge claims automatically.

Claims are currently lodged by either the participant, provider or the NDIS after a provider has provided support to a participant, though which party does this depends on a participant’s plan type.

But the process is still manual, requiring the three parties to enter payment requests through the myplace payments portal, which - like other NDIS IT systems - is supported by Services Australia.

Participants and providers also experience lengthy delays between the provision of support and payment, meaning that participants often have to fund the support before receiving a payment.

The new solution is expected to solve these issues by providing “one simple, consistent, automated claims and payments process, directly between the provider and the NDIA, regardless of the participant’s plan”.

“This will dramatically reduce the effort, time and cost associated with making claims, receiving payments and resolving issues under the current payments processes,” the NDIA said.

The agency expects that “moving from the current portal based manual claim processing to real- time claims at the POS” will result in significant benefits for participants, providers and the NDIA.

For participants and providers, this includes reducing the financial burden on some providers to fund the support before claiming payment, reduced payment delays and errors and fewer overheads associated.

The real-time claims and direct payment solution, which will use Services Australia's existing payments gateway to process payments, will also give participants access to a real-time messaging capability.

The NDIA will also benefit through increased transactional data visibility and quality, strengthened fraud controls and improved payment correctness and reduced overheads associated with manual processing.

The solution will be expected to utilise application programming interfaces (APIs), which the NDIA has been developing since late last year to link-up its business systems in real-time.

Documents reveal the agency has now finished developing “a set of publicly available open REST APIs” that have been “deployed to production”.

“These APIs support many of the functions that are available on the myplace portals, including payment requests (claims),” the NDIA said.

The APIs will support real-time claims, and are also considered the first step towards the agency’s long-awaited digital marketplace or digital market service.

The government said the marketplace would be up and running from early 2020, though there has been no confirmation that this has occurred.

With more than $22 billion expected to be paid out through the scheme to 500,000 Australians with a permanent and significant disability each year within the next five years, the marketplace, as well as real-time payments, will only become increasingly important.

There are currently around 365,000 active participants in the scheme, up from around 90,000 in June 2017. Payments during 2018-19 totalled approximately $10.2 billion.