Provider compliance monitoring

Provider compliance letters

We are sending letters to providers who we have identified may have an error in a payment request.

We are asking providers to check the claim for payment and fix it if it is incorrect.

If you receive a provider compliance letter you should:

  • read the letter fully to understand what it is asking you to do
  • review the claim for payment, check whether it is correct and follow the direction in the letter to self-correct any error as soon as possible
  • if you need help correcting an error, contact the National Contact Centre (NCC) 1800 800 110.

Correct and incorrect claims for payment

The payments we are currently looking at are ones where the number of claims for a particular support are higher than average or appear to have been made in error. In this situation, it is likely that there has been a mistake made by the provider when making the claim.

We are prompting providers to double check that every detail is correct. 

It is important that all claims are fully correct. This includes administrative errors such as incorrect line items and dates even when the total amount is correct. It also includes any other payments you identify as incorrect, even if not listed in the letter.

A correct claim will show the:

  • right participant
  • exact support delivered and line item 
  • correct rate and correct date.

If you have checked your claims and they are correct, you do not need to do anything else and do not need to contact us. 

As part of our compliance monitoring, we might contact you in the future and ask you to provide information about supports and/or services you have been paid for. 

Details about the NDIA’s compliance approach, including what other actions may be taken, can be found on the fraud strategy page.

Record keeping

To show your claims are correct you must maintain complete and accurate records of supports delivered to Scheme participants. These include:

  • invoices
  • service agreements
  • other documents that can validate the claim for supports provided.

Providing this documentation allows the Agency to verify the quantity, type and duration of the support delivered if selected for a compliance review.

The NDIA undertakes a number of additional activities to monitor and assure provider compliance. These include regular payment testing and field based assurance activities

We also work with the NDIS Quality and Safeguards Commission to ensure compliance and protect participants.

The NDIA use data monitoring and analytics to detect errors and non-compliance. We do this to ensure the Scheme’s integrity and sustainability. 

We are constantly improving our ability to detect error and non-compliance with the latest tools and resources available. Doing this protects the integrity of the Scheme and ensures it is available to all eligible persons, now and into the future.

Where to go for more information

If you have received a provider compliance letter you can contact us for further information on 1800 800 110.

This page current as of
16 February 2021
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