NDIS Pricing, Claiming and Cancellations

NDIS prices are reviewed every year, and the way they are set changed in 2026. This lesson explains the annual pricing review, the Pricing Arrangements and Price Limits document that providers have relied on for years, and the new arrangement under which the Minister makes a pricing determination and the agency publishes pricing schedules. Key points: prices are reviewed each year and have usually changed from 1 July, the 2026 to 2027 pricing schedule took effect on 24 September 2026, claiming guidance is being updated, and managers must always check the current documents on the NDIS website rather than relying on memory.

Most NDIS support items have a maximum price. This lesson explains when price limits apply, what they include, and why the maximum can differ for the same support. Key points: maximum prices apply when funding is agency managed or plan managed, they include GST, they can differ by location using the Modified Monash Model, by time of day and day of week, and by complexity, group supports are shared between participants, providers can charge less than the maximum but not more, and the NDIS Code of Conduct means we must not charge participants more than we would charge anyone else.

Every claim must accurately reflect a support that was agreed with the participant and actually delivered. This lesson sets out the core claiming rules: claim after delivery, claim only what was agreed, use the support item that matches what was delivered, claim the right quantity and time, and claim within the time limit. Key points: partial units are claimed by the actual time spent, claims are made in units or hours but not both, the time limit for claims is reducing from 2 years to 90 days from 1 December 2026, and false claims are a serious compliance issue.

Some support items allow claims for work that is not delivered face to face, such as writing a report for other providers. This lesson explains the conditions for non face to face claims, the administrative tasks that can never be claimed, and introduces other claim types such as provider travel, telehealth and agency requested reports. Key points: non face to face work is only claimable when the item allows it, it is part of that participant's support, its value has been explained and it was agreed in advance, while general administration such as rostering, claiming and plan monitoring is covered by the price and must not be claimed.

When a participant cancels at short notice or does not show, a provider may be able to claim some or all of the agreed fee. This lesson explains the short notice cancellation rules as set out in the current claiming guidance. Key points: support items state which notice period applies, the guidance describes two clear business days for many therapy and professional supports and seven days for many support worker supports, providers can claim up to the full agreed fee, conditions apply, including that the service agreement covers cancellations and the worker could not be given other billable work, and claims use the same item with the cancellation option.

Cancellation rules are not just about billing. Repeated cancellations can signal that something is wrong in a participant's life or with our service. This lesson covers our duty of care when cancellations increase, fair use of discretion to waive fees, cancellations in group supports and programs of support, and good record keeping. Key points: there is no hard limit on cancellations but the agency monitors them, we look into unusual patterns and follow up on wellbeing, we apply our policy consistently and fairly, and every cancellation claim must be supported by clear records.

Every claim must be backed by records showing what was agreed and what was delivered. This lesson explains which records support a claim, what good evidence looks like, and the new record keeping requirements that began in August 2026. Key points: service agreements, rosters, timesheets, case notes and invoices should all tell the same story, records should be made at the time and be accurate, providers must keep records relating to NDIS claims and payments for 7 years, and the agency may require supporting documents for some claims in future.

Most providers do the right thing, but fraud and sharp practice take money away from genuine supports and harm participants. This lesson explains what fraud and sharp practice look like, the stronger compliance powers and offences introduced in 2026, and what to do if you have concerns. Key points: claiming for supports not delivered, inflating hours, using the wrong item to get a higher price, charging participants more than others and offering inducements are all unacceptable, the agency and NDIS Commission now have stronger powers, and staff must report concerns through our internal process or directly to the agency. The lesson ends with a module summary.

This case study follows Nadia, a team leader who checks her team's claims each week before they are submitted. In one week's batch she finds a shift claimed for longer than it ran, rostering time listed as non face to face support, a report claimed without agreement and claims sitting in a queue. The lesson walks through how she applies the core claiming rules, talks with her team, and fixes problems before they become overclaims. Key points: claims must match what was agreed and delivered, administration is never claimable, and prompt processing matters under shorter claim time limits.

This case study follows Mrs Okafor, a participant who has always been reliable with her supports but has cancelled several shifts at short notice in two weeks. Our finance officer wants to claim every cancellation. The lesson walks through checking each condition in the current guidance, putting wellbeing before billing, and using discretion to waive fees fairly. It also shows how to record decisions and review the schedule with the participant. Key points: every condition must be met before claiming, unusual patterns need follow up, and our policy should be applied consistently and fairly.