Unpaid or missing NDIS claims are identified by reconciling every submitted claim reference against the remittances received, and flagging any claim that appears in your billing system but not on a corresponding remittance line. The most common causes are a claim still sitting in “pending” or “held for review” status, a rejected claim that was never resubmitted, or a claim that was never actually submitted successfully despite appearing complete in an internal system.
What counts as a “missing” claim?
A claim is effectively missing when service was delivered, an invoice or claim record exists in your system, but no corresponding payment or remittance line has come through — and enough time has passed that it should have. This is distinct from a claim still legitimately within its normal 2–10 business day processing window.
How can providers systematically find unpaid claims?
- Reconcile by claim reference, not by eye. Match every submitted claim in your billing system against remittance lines received, rather than only checking bank deposits against expected totals.
- Age your outstanding claims. Anything unpaid beyond the normal processing window (2–3 business days for standard claims, up to 10 for held or unregistered-provider claims) should be flagged for follow-up.
- Check the myplace provider portal directly for anything flagged in your own system as sent but unconfirmed. A claim that failed to upload correctly may show no record in the portal at all, which looks different from a claim that’s pending or held.
- Don’t let rejected lines disappear from view. A rejected claim line is easy to net off silently during reconciliation — treating every rejected or unmatched line as a decision point (resubmit, credit, or write off) prevents claims from quietly going unpaid.
What should happen once a missing claim is found?
- If it was never successfully submitted, resubmit it — check it isn’t past the 90-day submission window from the end of the service booking first.
- If it’s genuinely still processing, no action is needed beyond continued monitoring.
- If the portal shows no record of it at all, raise a payment enquiry through the my NDIS provider portal rather than assuming it’s simply delayed.
