How Do NDIS Reimbursements Work?

Key information

• A reimbursement is when you pay for a support yourself and later claim the cost back. It's the main option for self-managed participants; if you're plan or agency managed, this is only needed occasionally.
• Whatever you're claiming for must be an approved, reasonable and necessary support that's written into your current plan, with funding available in your current funding period.
• Where possible, direct provider invoicing is the ideal option for most participants – it's faster, and you're never out of pocket in the meantime.
• A recent ANAO audit found reimbursement claims may get more scrutiny from the NDIA than provider claims.

What is an NDIS reimbursement?

A reimbursement is when you pay for a support out of pocket, and later claim it from the National Disability Insurance Agency (NDIA). You would mainly use this option if you were self-managed. If you’re plan-managed, your plan manager will typically work directly with your providers for invoicing. If you’re agency managed the NDIA will also work directly with your providers.

If you’re requesting reimbursement, it must still be for an approved support that aligns with your NDIS plan as written. That means:

• You have funding available in your current NDIS plan for that category
• You’re purchasing a disability-related support that is considered reasonable and necessary by the NDIS
• Your claim meets all the compliance and documentation requirements

When can you be reimbursed?

Reimbursement is definitely not the ‘default’, and it’s a lot easier to get your providers to work directly with your plan manager or with the NDIA.

Sometimes you may pay for something with your own money, even if it’s a support or service that’s been approved in your current NDIS plan. For example:

• You run out of health consumables or continence products, and need to purchase more immediately.
• You have a transport budget to help you get to events or appointments, and you pay for taxis out of pocket.

For most NDIS supports it’s better to have the provider claim directly with your plan manager, rather than paying for things yourself and applying for reimbursement.

3 steps to request a reimbursement for NDIS supports

Provide an itemised tax invoice or receipt

If you have an invoice to submit, make sure it meets the ATO’s minimum invoicing standards. This needs to show:

• When you made the purchase
• NDIS provider name and ABN (or business name and ABN if buying something from a non-NDIS provider)
• A description of the support or product purchased
• The amount paid (showing you have paid, in full, the amount you are trying to claim)

Check if it’s in your current plan (and current funding period)

The support you’re claiming reimbursement for must fit within the approved categories and supports written into your plan, and you must have funding available in your current funding period.

Related: New Changes to NDIS Funding Periods

Submit your claim

If you’re self-managed you will need to log into the ‘my NDIS’ app or portal, then click on ‘Claims’ and ‘Make a Claim’. You’ll be prompted to enter the relevant details from there.

If you’re a plan-managed participant, you can submit your reimbursement request to your plan manager. NDSP-managed participants can use our straightforward client reimbursement claim form.

Why would a reimbursement not be accepted?

Reimbursements may not be approved by the NDIA for much the same reason as regular provider claims – because they’re not compliant with your plan as written. If you are submitting for reimbursement, you should check:

1. That the purchase fits what is outlined in your current NDIS plan. For example, you couldn’t use consumables funding as a replacement for transport funding if you didn’t have transport specified in your plan.
2. That you have funds available for this support in your current funding period. If you don’t have sufficient funds, the reimbursement won’t be approved.
3. That your purchase would be considered an NDIS support.

If you’re not sure whether the support you want to purchase aligns with your plan and available funding, you can ask your plan manager for help. We’re always happy to answer questions for our clients about what their budgets may cover – it’s better to ask the experts beforehand than to be caught short later.

Note: A recent ANAO audit indicates that ‘plan manager reimbursement claims’ are more likely to be reviewed by the NDIA’s compliance teams than ‘standard claims’ submitted by a provider. While it’s not a stated rule, this trend means that reimbursements may end up under greater scrutiny than provider claims – though both will absolutely need to be compliant with your plan and NDIS guidelines.

Setting up direct claims with NDIS providers

As part of setting up your service agreement, you can ask providers to invoice your plan management provider directly. Plan management is designed to help simplify this part of the process for you, and to add a layer of checks to make sure everything is the way it should be before submitting claims to the NDIA.

How NDSP handles participant reimbursement claims

It’s usually easier and faster to have the provider send their invoice to us directly, because it streamlines the process. NDIS reimbursements typically take longer than processing provider invoices because we need to validate your proof of payment first. You might be out of pocket for longer than you’d like if you pay yourself and then claim it back.

As plan managers, our job is to ensure compliance in all claims submitted against your plan – whether you submit them yourself, or they come directly from a provider.

If you’re submitting a claim for reimbursement, we need proof of payment. You can upload this in the online reimbursement form.

Our client reimbursement claim form asks for details such as:

• Your name
• Your email
• The client’s name (if you’re submitting on behalf of a participant, this is where their name goes)
• NDIS number
• Bank details – including whether we’ve processed a reimbursement for this bank account, and how many claims you’d like to make
• Claim information – amount, and a space for additional notes if there’s more detail we should know
• Documentation – receipts or invoices can be loaded in a range of file formats

Once we have your details, we will run the request through internal verification and checks before sending it to the NDIA. This helps us pick up any errors or missing information before it becomes an issue.

Keeping track of your plan is easy with NDSP Plan Managers

Whether you’re submitting a claim for reimbursement or it’s business as usual with providers sending invoices directly, NDSP’s comprehensive plan management services can help smooth the process and take the financial admin off your plate.

You can see your NDIS plan budgets, with live totals updated as soon as claims are processed, on our easy-to-use Nappa portal. Nappa can be accessed on any device, any time of day – so you’re never waiting on anyone else if you want to see how much you’ve spent and how much remains in your approved support budgets.

If you’re not sure what something means in your plan budget, we’re happy to help with that too. Our friendly team of NDIS experts is available on 1800 63 63 77 during business hours (Monday to Friday, 8:30AM to 5:30PM ACST) with an average wait time of 75 seconds or less. If you prefer email or can’t call during these hours, that’s fine – you can also use our easy contact form. Why not get in touch today to find out how NDSP can help you manage your NDIS plan. We’d love to hear from you!