Common NDIS Billing Errors and How to Fix Them

1. Time Band Errors

NDIS rates change based on the time of day and day of week the support was delivered. Weekday Daytime, Weekday Evening, Saturday, Sunday, and Public Holiday each carry different rates. The most common error is claiming a weekday evening or weekend shift at the weekday daytime rate, usually because the claim was entered from a timesheet without checking the actual hours delivered.

How to fix it: Build a claim review checklist that cross references every shift against the NDIS time band table before the claim is submitted. For providers with high weekend or evening volume, this alone can uplift monthly revenue by 5 to 12 per cent.

2. Line Item Code Mismatches

Community Participation (CP) claimed when Capacity Building (CB) was the correct category. ADL claimed at the wrong intensity tier. Transport claimed under the wrong support item. Each of these mistakes either leaves revenue on the table or creates claim rejection risk.

How to fix it: Map each support you deliver to the exact line item code in the current NDIS Pricing Arrangements and Price Limits. Build the mapping into your rostering or billing system so the code is set at the point of service, not at the point of claim.

3. Ratio Errors (1:1, 1:2, 1:3)

Group supports must be billed at the correct participant to worker ratio. A 1:2 support is billed at half the 1:1 rate per participant. Providers frequently claim 1:1 rates for group shifts either by mistake (overbilling, which is a compliance issue) or under claim group shifts at higher ratios than they actually ran (underbilling).

How to fix it: Record the ratio at the shift level, not the claim level. Audit a sample of group shifts each month to confirm the claimed ratio matches delivery.

4. Public Holiday Loadings Missed

Public holiday rates are materially higher than weekend rates. Manual claim entry frequently misses them entirely, particularly for state specific public holidays that do not appear on every provider's internal calendar.

How to fix it: Load the current year public holiday calendar into your rostering system. Any shift on a PH date should default to the PH rate and require manual override to reduce, not manual addition to apply.

5. TTP (Temporary Transformation Payment) Missed

TTP applies to certain registered providers and adds a loading to specific line items. Providers eligible for TTP sometimes claim at the standard rate out of habit, especially when onboarding new billing staff.

How to fix it: Confirm your TTP eligibility. If you qualify, build the loading into your default claim template for the relevant line items.

6. Short Notice Cancellation Claims Not Submitted

The NDIS short notice cancellation policy permits providers to claim cancelled shifts under defined conditions. Many providers do not claim these at all, either because they are unsure of the rules or because the cancellation was never captured in the system.

How to fix it: Require every cancellation to be logged with a reason code and timestamp. Train staff on the current cancellation claim rules and include cancellations in the weekly claim run.

7. Travel Time and Non Labour Costs Not Claimed

Provider Travel rules allow claims for travel time and in some cases non labour travel costs. Providers often claim neither, particularly for rural or regional supports where travel can represent a meaningful slice of the cost base.

How to fix it: Record travel time on every applicable shift at the rostering stage. Apply the correct Provider Travel rates at claim time. Check eligibility for non labour travel costs.

8. Rejected Claims Never Resubmitted

Rejections from the PRODA portal or the provider portal are often left unresolved, especially when the rejection reason is unclear. Every unresolved rejection is revenue stuck in limbo.

How to fix it: Build a rejection register. Every rejection goes on the register with the reason code, the resolution action, and the resubmission date. Target zero rejections carrying over week on week.

How We Help

Our NDIS revenue audit tests your claims against every error category above. If you are specifically running SIL supports, the SIL billing audit goes deeper into shift level ratio and time band review.