If a Plan Manager or Participant does not provide plan dates how will Providers keep track?
Whilst there is no hard end date for PACE plans, there is a rolling 'next review date' for each plan, which will typically be 1 year after the plan's start date. This date is currently only visible through the use of the NDIA APIs.
When you say real time claiming, does it support same day payments as well? i.e. if I were to submit a claim for payment, I will get paid within the day?
Real time claiming will mean you can claim in real time but the payment will still take 2-10 days if it’s a PACE participant.
If there isn't an end date for PACE plans, how will Providers be able to ensure that there are funds available?
Unfortunately, you won’t. It’s the number one concern of providers and something we’ve raised multiple times with the NDIA. The best solution is to enable real-time claiming of payments so that the lag between service provision and payment authorisation is minimised. This way, Providers will also become aware of any payment shortfalls before they escalate.
What about for high-cost plans like SIL?
NDIA have confirmed that claiming for SIL, SDA and PBS will be automatically rejected if the provider is not listed as a My Provider, and that My Provider status will not be automatically applied for SIL. The NDIA did note that the choice of providers would be discussed at the participant meeting to reduce the delay in appointing a My Provider.
What are the requirements for funding of the "Improved Relationships" of capacity building budget category?
For the "Improved Relationships" sub-category, participants need to endorse the provider specifically for this funding type and nominate the date from which the endorsement applies, or payments will be rejected. Often we are not advised of a plan ending so we have serviced a new plan period already. To get the participant to approve us, the service type and the date is proving very challenging and the PACE system doesn't show why the payment has been rejected.
Do we need participant consent to see their API data?
Under PACE, general providers, support coordinators, psychosocial recovery coaches, and plan managers recorded as ‘my providers’ will automatically see a participant’s contact details and the details of their nominee/s (if they have them). Upon gaining consent from the Participant, registered providers will be able to view a participant’s goals and nominee details.
In regards to the open claims that are waiting for approval, how and when do you know when a claim has been approved?
At the moment, a the Participant will be notified about the provided service and has 7 days to dispute or approve the claim. There is no way for providers to be notified that a claim has been approved unless you're using a service that has access to the NDIA APIs, in which case, you'll be notified of the change in status of a claim as soon as it’s approved.
Has PRODA made a change whereby they will identify when a customer is PACE funded and not check back to the service booking?
All new participants into the scheme will have a plan number starting with 53, which will help to identify PACE participants. For all transitioning participants the plan number remains the same but on the back end they will be marked as PACE and will be funded by PACE.
With Analytics in quickclaim - is this functionality available only for NDIA-managed participants or it cover everyone including plan-managed and self-managed participants?
quickclaim sources data from many applications so the analytics will cover participants with plans managed by the NDIA, plan managers and themselves.
What accreditation/certification does quickclaim have in terms of RFFR and ISO27001?
quickclaim is ISO 27001 certified and complies with the Digital Partnership Office's additional security requirements. You can find out more about the DPO's requirements here.
Our organisation relies heavily on forecasted funds in order to provide not only quality and adequate support, but also to do continuous staffing adjusments across our larged (DES) program. What accomodations are in place for providers to do this if budget and end dates are obscured?
Ultimately, the NDIA is encouraging more providers to access data through their APIs. This also helps reduce the lag between claiming and getting paid for services and improves cash flow. If you would like more information about how this works, please visit https://quickclaim.io/ndis-payments/.
Providers are concerned that participants may overspend their budgets in PACE. How will the NDIA manage overspending?
There are additional controls in place for some support budget categories and there will be an increased focus on monitoring. Plan managers and support coordinators will also continue to play an important role in supporting participants to manage their budgets effectively. The NDIA also continues to recommend providers have clear service agreements in place with participants and process claims on a regular cycle.