NDIS to implement real-time claims and payments system

The agency responsible for Australia's National Disability Insurance Scheme is seeking to implement an automated claims and payments process.

The National Disability Insurance Agency (NDIA) is looking to develop and implement a Real Time Claims and Direct Payment solution for all participants of Australia's National Disability Insurance Scheme (NDIS).

In a request for tender (RFT), NDIA said the claims and payment solution would provide one "simple, consistent, automated claims and payments process, directly between the provider and the NDIA".

The NDIA hopes to dramatically reduce the effort, time, and cost associated with making claims, receiving payments, and resolving issues under the current payments processes.

Currently, participants receive support services from providers and claims for payment are usually lodged after the event through either the myplace Participant or myplace Provider online portals.

The RFT said existing payment processes result in a number of issues being experienced by participants, providers, and the NDIA, including the manual entry of payment requests into the portals; potentially lengthy times between supports being provided and payment being received; payment correctness, payment integrity, and fraud; and insufficient collection of data on supports being provided to participants.

The NDIA said in some instances, a .csv file is uploaded to the NDIS portal, providing details of a number of claims.

To fix the archaic process, the NDIA is seeking to develop a solution that enables providers and participants to automatically lodge claims, known as payment requests, in real time at the point of support.

The RFT said this solution should utilise NDIA application programming interfaces (APIs) and leverage other digital capabilities.

The NDIA currently utilises an IT platform delivered and supported by Services Australia to support the core operations of the NDIA. This includes the myplace Participant Portal and the myplace Provider Portal, which currently provide web-based access to information regarding participants and providers and support online processing of all critical NDIS functionality.

A set of publicly available open APIs have recently been developed and deployed to production, the NDIA said, noting the APIs support many of the functions that are available on the myplace portals, including payment requests.

Using these APIs, the NDIA developed a mobile application that enables some of the functions currently performed on the myplace Participant portal to be completed on a mobile device.

NDIA said the app could be expanded to support real-time claims.

The NDIA said implementing a new claims and payments system would result in the increased visibility and quality of transactional data, strengthen controls and "improve payment correctness and reduce fraud", reduce agency costs, and also see a reduction in payments issues.

See also: Centrelink's new data-matching project targets Medicare fraud

To the participant, of which there were 365,000 active participants in March 2020, the benefits are listed as giving choice and control, reducing time spent on administrative tasks, and enabling real-time messaging capability to support the validation of claims and updates on budget positions.

Benefits for the provider were similarly listed as offering less administrative overhead, a reduction in payment errors, a reduction also in delayed payments, and eliminating the need for plan managers and participants to be financial intermediaries.

In the six months to 30 December 2019, 17.6 million claims were processed. Payments across the NDIS during the financial year 2018-19 totalled approximately AU$10.2 billion, with the majority of these payments having been made directly to providers on behalf of participants.

The NDIA said it is also implementing tech from Salesforce and its wholly-owned company MuleSoft. NDIA in December went to tender for a cloud platform to help with the delivery of the NDIS moving off the Services Australia-run Salesforce CRM.

The RFT closes on 5 June 2020.

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