100 days in and the aged care sector is still finding its feet. This isn’t a criticism. It’s an honest read of where things are.
The scheme is working, and for providers who were ready on November 1, it has worked (more-or-less) since day one. Services Australia’s APIs were live, their engineers were responsive and the system did what it was supposed to do.
Where things have gone wrong, the culprit has generally been software vendor readiness and data quality rather than the government’s infrastructure. About half of the major suppliers were well set up, and the providers relying on the other half have felt it – that is where most of the pain in the sector right now is coming from.
Claiming was the first hurdle. Statements are next.
Getting claims lodged was hard enough for many providers, some of whom entered the new scheme still trying to finalise their HCP claims from the prior period. The extension of claim windows was the right call by Services Australia and most providers are now moving past that first hurdle.
Statements are where the real complexity sits. Unlike a basic financial report, a participant statement is a document that families scrutinise and that creates genuine compliance exposure if it is wrong.
Generating an accurate one means reconciling claims, co-contributions, budget allocations and payment records at a level of detail that manual processes simply cannot sustain. The providers doing this well have systems that handle the reconciliation automatically. Everyone else is working through spreadsheets, and that is a problem that will compound over time.
What a good transition looks like
One of quickclaim’s clients, Rise Network – a Perth-based not-for-profit working across disability, aged care, mental health and youth services – had already moved their NDIS claiming into a purpose-built system before November 1.
That prior work meant they arrived at the transition with API connectivity in place, known data exports from their scheduling system and a working finance integration already set up. The residual work was still significant, but the foundation was solid enough to build on quickly.
When asked what capabilities they found most valuable, Rise Network Financial Systems Controller Cara Sinclair pointed to:
- Pre-submission validation that catches errors before they reach Services Australia
- Full audit trails across all transactions
- Bulk edit capability for fixing errors at scale
- A vendor who keeps pace with legislative changes
An unexpected upside from the transition has been improved cash flow. By claiming weekly for external expenses rather than monthly, Rise is now claiming for some vendor costs before their 30-day payment terms even fall due.
What we would have done differently
Requiring providers to produce participant statements in the same month they were still finalising their first claims was ambitious to the point of impractical. A temporary amnesty on statements would have taken real heat out of the rollout, giving the sector time to stabilise claiming before adding that layer of complexity.
The guidance on statement formatting did not help either. A 10-page Word document is thorough, but it is not a working template, and a simple default format issued early would have done considerably more to help providers get moving.
What’s coming next
The price cap introduction (planned for June) is the next significant milestone, and the pre-work needs to start now regardless of whether it lands on schedule. Re-pricing agreements, renegotiating rate cards and remodelling margins all take time, and providers who wait for confirmation before starting will find themselves under pressure.
The first quarterly rollover of unspent funds is also worth watching closely. March 1 was the expected date for the first rollover covering the initial two-month funding period from November, and at the time of our webinar there was some uncertainty about whether rollover data had appeared for providers, with at least one attendee reporting they could see it on their end. If you have not checked yet, now is the time.
Beyond that, the assurance program is active and Services Australia now holds complete transaction-level data for the sector, meaning providers with clean audit trails and accurate claiming records are well placed, while those still managing data manually are increasingly exposed. Services Australia has also announced an entry/exit API that should make a meaningful difference to claiming failures caused by participants not being correctly activated in the system.
The honest summary
The first 100 days have been hard in places and smooth in others, but the scheme itself is not broken – and a clear path to sustainable claiming does exist. Getting there just requires the right systems, the right data discipline and a willingness to move away from manual processes that were never built for this.
Based on insights shared at our Support at Home 100-Day Review webinar with Cara Sinclair (Rise Network), Luke Benson (Blue Bike Solutions) and Amir Hosseini (quickclaim).
Ready to get your Support at Home billing on track?
If the first 100 days exposed gaps in your current setup, we’d love to talk. quickclaim has been working with providers since day one and we’re ready to help you get claiming right from here.
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