Why was my NDIS claim rejected or skipped?
What skipped and rejected mean in the Funding Exchange, what common NDIA rejection messages mean, and how to fix and resend a claim.
Key Points
Skipped means FlowLogic didn't send the item. Something is missing, such as the NDIS number, plan dates, support item or an amount, or the item isn't claimable through the Funding Exchange because the client is plan managed or self managed.
Rejected means the NDIA sent the claim back. FlowLogic shows the NDIA's reason but doesn't create it. To read it, click Review on the claim request, then click Rejected on the line.
The most common rejection is "The unit price claimed is above the NDIS price limit." It usually comes from a 2:1 ratio or the item's unit type. Add more quantity instead of using a ratio that raises the price.
To resend a claim, fix the issue, set the item to Retry in the Funding Exchange, search the roster period again and export the claims again.
To claim a cancelled shift, set the billing flag to CANC and complete the shift.
What's the difference between skipped and rejected?
When you click Find Claims in the Funding Exchange, FlowLogic checks every item in your search. Items it can claim are listed for export. Items it can't claim are skipped, with a warning, and aren't sent.
Items that are sent go to the NDIA. If the NDIA doesn't accept one, it comes back as Rejected with the NDIA's reason.
Why was my claim skipped?
FlowLogic skips an item when something it needs is missing or the item isn't claimable through the Funding Exchange. Check:
NDIS number: the client needs an NDIS number in FlowLogic, with no spaces in it.
Plan dates: the service date must be inside the dates of a current funding allocation.
Support item: the shift's billing must be a valid support item, picked from the client's Allocated Items list.
Amount: an item worth $0 isn't claimed.
How the client's funding is managed: plan managed and self managed clients are invoiced, not claimed.
Two skip warnings you'll often see:
Matched item allocation not authorised for claiming: the item belongs to an allocation that is invoiced, usually a plan managed or self managed client. It goes to Export Invoices instead. If that's right for the client, you can ignore it.
Item has already been exported: the item was claimed before. It won't be sent again unless you set it to Retry.
To see every skipped item from your search, click Download Skipped Claims. The button only works when at least one item was skipped.
Where do I see why a claim was rejected?
Go to Finance and Payroll > Funding Exchange.
Under Claim Requests, find the claim and click Review.
Click the Rejected status on the line. The line history shows the NDIA's reason.
The NDIA writes the rejection reasons, not FlowLogic. If a reason isn't listed below, or you're still not sure why the NDIA rejected the claim, contact the NDIA. Our Support team can't get the reason from the NDIA for you.
What do common rejection messages mean?
"The unit price claimed is above the NDIS price limit."
The price per unit on the claim is higher than the NDIS price for that support item. The usual causes are:
A ratio that raises the price, such as 2:1. A ratio changes the unit price, not the hours. For two workers with one client, remove the ratio and increase the quantity instead. See How do I add billing to a shift?
The unit type: check the item's unit, such as hourly, each or weekly, matches how you're billing it. Rounding on part-hour units can also take the price a few cents over the limit.
"Provider is not registered for this support item."
The NDIA's records don't show your organisation as registered to deliver that support item. Check the shift uses the right support item. If it does, check your registration with the NDIA.
"Claim Type selection not allowed for support category"
The claim type sent with the line, for example a cancellation, isn't allowed for that support item's category. Check the billing flag on the line is right. If it is and the claim is still rejected, contact our Support team.
"No Service booking found"
The NDIA can't find a service booking with your organisation that covers the support and date. Check the service booking in the NDIS portal, then resend the claim.
[CODE=V33]
The NDIA says: "The claimed support is plan-managed for the claim period and the provider does not have the plan manager role." The support should be invoiced to the plan manager, not claimed from the NDIA. Check the client's funding allocation is set up as plan managed. See How should I set up funding allocations for self-managed, plan-managed and NDIA-managed participants?
[CODE=V23]
The NDIA says: "The claimed support is self-managed for the claim period and can't be claimed by providers." The support should be invoiced to the client. Check the client's funding allocation is set up as self managed.
"Claim can't be processed. There are multiple fields which need checking. Please check all information and resubmit or contact us."
The NDIA found more than one problem with the claim. Check the client's NDIS number, the service dates, the support item and the price. If you can't find the problem, contact the NDIA.
Other common causes
The claim crosses two plans: a claim whose dates span two plans or two allocations is rejected, for example a weekly item when the new plan starts mid-week. Claim the days in each plan separately. If you need a daily version of a weekly item, contact our Support team.
Provider registration number: claims can't be exported without your NDIS provider registration number in FlowLogic. Our Support team sets this, so contact us if it's missing or wrong.
How do I resend a rejected or skipped claim?
Fix the cause, for example the billing on the shift, the client's NDIS number or the funding allocation.
Go to Finance and Payroll > Funding Exchange, open the claim request with Review, and set the item to Retry. To retry a whole batch, use Reset and Retry.
Search for the roster period again with Find Claims. Make sure your dates cover the item, or it won't be found.
Export the claims again.
Once you've set an item to Retry, don't change its status again. Items stay at their current status, including Rejected, until you set them to Retry. This stops the same service being claimed twice. For more on claim statuses, see How do I check and resubmit Funding Exchange claim requests?
If a plan managed or self managed item was claimed by mistake, set it to Retry after fixing the allocation. It won't be found as a claim again, and goes to Export Invoices instead.
How do I claim a cancelled shift?
Set the billing flag on the client's billing line to CANC, then complete the shift. This applies to any support item. A shift cancelled with notice isn't charged, so it won't be claimed. For cancellation types, see How do I cancel a shift?