COURSE OVERVIEW:

Welcome to the Interpreting & Using NDIS Pricing Arrangements for Accurate Claims course. This comprehensive program is designed to build your capability to read, interpret and apply the NDIS Pricing Arrangements and Price Limits with confidence, so that every claim you submit or approve is accurate, defensible and aligned with the participant’s plan and support outcomes. You will explore how the Pricing Arrangements sit within the broader NDIS pricing framework, how they interact with supports, plans and service delivery models, and how disciplined invoice validation processes directly support payment integrity, regulatory compliance and a better experience for participants and providers.

This course begins by introducing the purpose and intent of the NDIS Pricing Arrangements and Price Limits, clarifying why this document exists and how it underpins consistency, fairness and value for money across the scheme. It explains the role of service providers and financial staff in claims validation, consistency and payment integrity, and explores the practical consequences of misinterpretation, including rework, complaints, payment delays, remediation activities and the risk of repayment or investigation when claims are not supported by the rules.

The next component places the Pricing Arrangements and Price Limits within the broader NDIS pricing framework, explaining their relationship with the NDIS Support Catalogue and other pricing-related guides and determinations. This section describes how these documents interact, how addenda, version changes and effective dates are communicated, and how to determine which version applies to a particular service date. It also shows you how to recognise when another pricing document governs item selection or claiming for a given scenario, so that you do not rely on outdated or incomplete references.

You will then examine how the Pricing Arrangements and Price Limits document itself is structured, so that you can navigate it quickly and logically. This section outlines the overall layout of the document, distinguishes general claiming rules from category-specific price limits, and explains how rules, tables and conditions interact in practice. It highlights the high-frequency rule sections used in daily invoice checking and shows you how to recognise when general rules override individual price tables, ensuring that you follow the correct rule hierarchy rather than relying on price columns alone.

Building on this, the course explores priority of interpretation and the decision hierarchy to use when multiple sections appear relevant to a claim. This section explains how to determine which rule applies when rules, tables and invoice descriptions seem to conflict, and how to manage apparent inconsistencies without defaulting to guesswork. It guides you in applying a consistent rule hierarchy to decision-making and in documenting the rule pathway used to reach a claim decision, so that your reasoning is transparent and audit-ready.

You will then develop practical navigation skills for working with the Pricing Arrangements quickly and accurately in high-volume environments. This section focuses on developing a rapid rule-lookup approach, using consistent terminology and keywords to locate rules efficiently, and building internal familiarity with common rule locations. It emphasises avoiding memory-based interpretation and informal assumptions, and introduces the claims context and funding management arrangements that influence how you interpret and apply the document in real invoice scenarios.

The course then examines how different funding management arrangements change the way you review invoices and apply the Pricing Arrangements. This section outlines plan-managed claiming responsibilities and constraints, agency-managed claiming considerations that affect pre-payment invoice review, and the characteristics of self-managed claiming that influence invoice structure and detail. It also addresses mixed management arrangements within a single participant’s plan and how to manage overlaps and duplication risks across providers operating under different management types.

You will then explore support purpose, categories and item structure as the foundation for correct claim interpretation. This section explains how support purpose and outcome alignment drive item selection, the relationship between support categories and claiming logic, and how registration group relevance links to item delivery and billing. It also shows you how to validate that the unit of measure (hours, kilometres, each, per day, per item) is correct before any rate checking, preventing structural errors that cannot be fixed simply by adjusting price.

Service agreements, service bookings and other claim preconditions are then examined as critical controls that sit alongside the Pricing Arrangements. This section explores the role of service agreements in setting conditions around cancellations, travel and programs of support, and how service bookings (or their successor arrangements) affect claiming validation and provider selection. It explains how provider selection controls reduce duplication risk, and how to align invoice claims with agreed service conditions so that claims reflect what was actually agreed and delivered.

The course then steps through a standard, repeatable invoice validation workflow that you can adapt to your organisation. This section covers confirming participant identity, plan status and service date eligibility, validating support purpose and funded relevance, and matching invoice lines to the correct support items. It explains how to check unit logic and claimed quantities, validate rates against applicable price limits, and apply relevant general claiming rules before making an accept, query, partial accept or reject decision for each invoice line.

You will also examine invoice structure requirements that enable clean claim matching and minimise manual intervention. This section explains how to ensure invoice lines align with claim submission requirements, how and why to separate service delivery, travel and other components, and how bundled charges can prevent compliant claiming or mask non-claimable items. It also addresses handling partial payments, split claims and re-issued invoices in a consistent way that maintains clarity for participants, providers and internal systems.

The course then explores invoice detail standards and evidence sufficiency for compliant claim validation. This section outlines minimum description requirements, how to assess the clarity and completeness of invoice information, and how to identify when clarification is required from the provider. It emphasises the importance of applying consistent evidence thresholds across staff so that similar invoices receive similar treatment, reducing disputes and internal rework.

You will then examine invoice compliance essentials and tax requirements that intersect with NDIS claiming rules. This section explains required invoice and tax invoice fields, how ABN and GST treatment interact with price limits, and how to manage missing or incorrect compliance details. It focuses on standardising correction requests so that providers receive clear, consistent information about what needs to be fixed, reducing back-and-forth and speeding up payment.

Service dates, claim periods and corrections management are then covered as key risk points for duplicate or invalid claims. This section shows you how to validate service dates against plan periods and relevant pricing versions, manage corrected and re-issued invoices, and handle credit notes and partial adjustments. It highlights methods to prevent duplicate claims during corrections, including systematic date and amount checking and clear documentation of adjustments.

The course then turns to quotation-based supports and special approval pathways, where additional evidence and governance are required. This section explains how to identify supports subject to quotation requirements, validate invoices against approved quotations, and understand evidence and documentation expectations for quoted supports. It also covers escalation and governance controls for quotation claims, including when to seek additional review or approval before payment.

You will also explore how to manage supports without published price limits. This section explains how to identify items that do not have set price limits in the Pricing Arrangements, how to apply reasonableness and defensibility checks to rates, and how to document decisions for non-standard pricing in a way that withstands review. It outlines escalation and oversight requirements for these claims so that they are not treated casually simply because they fall outside standard tables.

Non-face-to-face supports and report-based claims are then examined as specific claiming scenarios that can attract scrutiny. This section explains when non-face-to-face claiming is permitted, how to differentiate participant-specific work from general overheads, and how to validate descriptions, duration and relevance. It also addresses the distinction between NDIA-requested reports and routine documentation, and how that distinction affects item selection and claimability.

The course then focuses on telehealth claiming rules, which have specific eligibility and documentation requirements. This section explains the conditions under which telehealth delivery is allowed, related invoice description and service delivery requirements, and how to avoid common telehealth claiming errors and risks, such as incorrect items, double billing or inadequate evidence of participant engagement.

Travel claims and associated costs are examined in detail, given their complexity and frequent audit focus. This section covers eligibility conditions for travel claiming, how to validate travel time claims and applicable limits, and how to assess non-labour travel costs such as parking, tolls or accommodation. It also explains how to manage travel claims across multiple participants and prevent duplication or embedded travel charges that would breach the Pricing Arrangements.

You will then examine Activity Based Transport (ABT) claiming as distinct from provider travel. This section explains how to distinguish ABT from provider travel, the arrangements for ABT claiming for participation-related supports, and the principles for ABT claiming for capacity-building supports. It also highlights common ABT item and unit mismatches and how to resolve them before claims are submitted.

Short notice cancellations and non-attendance claims are then explored, as they are often misunderstood and contested. This section explains eligibility conditions and notice period logic, how to correctly structure cancellation claims, and how to distinguish cancellations from delivered supports in invoice records. It also covers managing participant concerns and disputes regarding cancellation charges in a way that is consistent with both the Pricing Arrangements and service agreements.

The course then addresses group-based supports and programs of support, where structure and attendance records become critical. This section shows you how to identify group-based supports correctly, apply rate division requirements, and validate group size and attendance logic. It also explains how to manage billing under programs of support and prevent over-claiming and structural errors where participants attend irregularly or services change mid-program.

Irregular rosters and time-of-day pricing rules are then examined as key drivers of complex rate calculations. This section explains time and day classifications and their impact on pricing, how to manage claims that cross time or day boundaries, and when invoice splitting is required to align with different loading periods. It also defines the minimum timing detail required on invoices to support time-of-day pricing decisions.

You will then explore regional, remote and very remote pricing arrangements, where location-based loadings apply. This section explains location-based pricing rules and eligibility, how to apply regional and remote loadings correctly, including partial-day or multi-location scenarios, and the evidence requirements to support location-based claims. It also highlights common errors in applying loadings and how to build internal checks to catch them.

Centre capital costs and establishment fees are examined next as specific charging types that are often misapplied. This section explains how to identify allowable centre capital cost claims, the eligibility and limitations around establishment fees, and how to structure invoices correctly for capital-related charges. It emphasises preventing incorrect or duplicated capital claims, especially where multiple providers or multiple claim types are involved.

Irregular Supported Independent Living (SIL) and high-complexity SIL claiming are then considered as high-risk, high-value areas. This section defines irregular SIL supports, outlines common billing risks in irregular roster arrangements, and explains validation and documentation requirements for these claims. It also identifies escalation triggers for high-risk SIL claims, such as unusual patterns, mismatched descriptions or unsupported complexity loadings.

The course then addresses complex claims involving multiple workers or multiple activities within the same time window. This section explains conditions for multiple-worker billing, the treatment of shadow shifts and supervision claims, and how to manage case conferences and coordination activities without duplicating time. It highlights the need for clear escalation pathways for complex scenarios, so that difficult edge cases are resolved consistently and recorded properly.

Prohibited charges and non-claimable costs are then examined to help you recognise when an invoice includes items that cannot be claimed from NDIS funds. This section explains how to identify prohibited fees and add-ons, manage co-payments and gap fees in a compliant way, and prevent bundled non-claimable charges from being included in NDIS claims. It also focuses on standardising responses to non-compliant invoices so that providers receive consistent and unambiguous feedback.

You will then explore red flags and payment integrity risk indicators that suggest a claim requires deeper scrutiny. This section covers mismatches between invoice descriptions and support items, duplicate claims across providers or time periods, unsupported or vague charging patterns, and patterns likely to trigger integrity review or investigation. It shows you how to embed these indicators into your routine checks without unnecessarily delaying legitimate payments.

Professional communication with providers is then examined as a critical skill for maintaining relationships while enforcing rules. This section focuses on neutral, clear communication about pricing issues, how to request specific corrections efficiently, and how to manage repeated non-compliance without escalating conflict. It also emphasises maintaining consistent messaging across the team so that providers receive the same guidance regardless of who reviews their claim.

The course then turns to internal decision notes and audit readiness, ensuring your decisions stand up to internal and external review. This section explains how to record defensible decision trails, document complex claim reasoning, and maintain consistency across staff when interpreting similar scenarios. It highlights how strong documentation reduces repayment and compliance risk, and supports constructive engagement with auditors and regulators.

Standardising invoice checking across teams is then addressed as a key driver of quality and efficiency. This section explores the use of shared validation workflows and checklists, templates and standard decision language, and strategies for reducing variation and second-guessing between staff. It also examines how standardisation can improve efficiency, reduce turnaround times and build confidence for both staff and providers.

You will then examine quality controls and governance practices that sit above day-to-day invoice checking. This section covers duplicate detection and reconciliation controls, sampling and quality assurance checks, and escalation thresholds for high-risk claims or providers. It also explains how to use trend analysis and quality findings to drive continuous improvement in processes, training and communication.

Managing pricing updates and rule changes is then explored as an ongoing operational requirement. This section explains how to track and interpret pricing updates, update internal tools and references, and brief staff efficiently on changes so that practice shifts at the same pace as the rules. It focuses on ensuring consistent adoption across the team and preventing “old rules” from lingering in daily decisions.

Finally, the course focuses on building confidence and consistency in pricing decisions at an individual and team level. This section supports you to apply rules with clarity and assurance, recognise when to escalate versus when to decide, and reduce reliance on informal advice or “word-of-mouth” interpretations. It links accurate, timely and defensible pricing decisions to an improved participant experience, better provider relationships and a more stable, predictable claims environment.

By the end of this course, you will be able to interpret and apply the NDIS Pricing Arrangements and Price Limits systematically across a wide range of claiming scenarios, structure and validate invoices in line with NDIS requirements, and document your decisions in a way that is transparent, consistent and audit-ready. You will have a clear, repeatable decision framework, stronger navigation skills for complex rules, and the confidence to manage edge cases, communicate with providers and support your team to deliver accurate, compliant and participant-centred claiming.

Each section is complemented with examples to illustrate the concepts and techniques discussed.

LEARNING OUTCOMES:

By the end of this course, you will be able to understand the following topics:

1. Introduction to the NDIS Pricing Arrangements and Price Limits

·       Purpose and intent of the Pricing Arrangements and Price Limits

·       Role of service providers in claims validation, consistency, and payment integrity

·       Consequences of misinterpretation, including rework, complaints, delays, and repayment risk

2. The Pricing Arrangements and Price Limits Within the NDIS Pricing Framework

·       Relationship between the Pricing Arrangements and the NDIS Support Catalogue

·       Interaction with other pricing-related guides and determinations

·       Understanding addenda, version changes, and effective dates

·       Knowing when another pricing document governs item selection or claiming

3. How the Pricing Arrangements and Price Limits Document Is Structured

·       Overall layout and logic of the document

·       Distinguishing general claiming rules from category-specific price limits

·       Understanding how rules, tables, and conditions interact

·       Identifying high-frequency rule sections used in daily invoice checking

·       Recognising when general rules override price tables

4. Priority of Interpretation and Decision Hierarchy

·       Determining which rule applies when multiple sections appear relevant

·       Managing apparent conflicts between rules, tables, and invoice descriptions

·       Applying a consistent rule hierarchy in decision-making

·       Documenting the rule pathway used to reach a claim decision

5. Navigating the Pricing Arrangements Quickly and Accurately

·       Developing a rapid rule-lookup approach for high-volume processing

·       Using consistent terminology and keywords to locate rules

·       Building internal familiarity with common rule locations

·       Avoiding memory-based interpretation and informal assumptions

·       Claims Context and Funding Management Arrangements

6. Plan-managed claiming responsibilities and constraints

·       Agency-managed claiming considerations that affect invoice review

·       Self-managed claiming characteristics and invoice differences

·       Mixed management arrangements within a single participant context

·       Managing overlaps and duplication risks across providers

7. Support Purpose, Categories, and Item Structure

·       Understanding support purpose and outcome alignment

·       Relationship between support categories and claiming logic

·       Registration group relevance to item delivery and billing

·       Validating correct unit of measure before rate checking

8. Service Agreements, Service Bookings, and Claim Preconditions

·       Role of service agreements in cancellations, travel, and programs of support

·       Service bookings and their impact on claiming validation

·       Provider selection controls and duplication risk management

·       Aligning invoice claims with agreed service conditions

9. Standard Step-by-Step Invoice Validation Workflow

·       Confirming participant, plan, and service date eligibility

·       Validating support purpose and funded relevance

·       Matching invoice lines to correct support items

·       Checking unit logic and claimed quantities

·       Validating rates against applicable price limits

·       Applying relevant general claiming rules

·       Making accept, query, partial accept, or reject decisions

10. Invoice Structure Requirements for Clean Claim Matching

·       Ensuring invoice lines align to claim submission requirements

·       Separating service delivery, travel, and other components

·       Managing bundled charges that prevent compliant claiming

·       Handling partial payments and re-issued invoices consistently

11. Invoice Detail Standards and Evidence Sufficiency

·       Minimum description requirements for claim validation

·       Assessing clarity and completeness of invoice information

·       Identifying when clarification is required

·       Applying consistent evidence thresholds across staff

12. Invoice Compliance Essentials and Tax Requirements

·       Required invoice and tax invoice fields

·       ABN and GST handling in relation to price limits

·       Managing missing or incorrect invoice compliance details

·       Standardising correction requests to reduce rework

13. Service Dates, Claim Periods, and Corrections Management

·       Validating service dates against plan periods

·       Managing corrected and re-issued invoices

·       Handling credit notes and partial adjustments

·       Preventing duplicate claims during corrections

14. Quotation-Based Supports and Special Approval Pathways

·       Identifying supports subject to quotation requirements

·       Validating invoices against approved quotations

·       Evidence and documentation expectations for quoted supports

·       Escalation and governance controls for quotation claims

15. Supports Without Published Price Limits

·       Identifying items without set price limits

·       Applying reasonableness and defensibility checks

·       Documenting decisions for non-standard pricing

·       Escalation and oversight requirements

16. Non-Face-to-Face Supports and Report-Based Claims

·       When non-face-to-face claiming is permitted

·       Differentiating participant-specific work from overheads

·       Validating descriptions, duration, and relevance

·       Managing NDIA-requested reports versus routine documentation

17. Telehealth Claiming Rules

·       Eligibility conditions for telehealth delivery

·       Invoice description and service delivery requirements

·       Common telehealth claiming errors and risks

18. Travel Claims and Associated Costs

·       Eligibility conditions for travel claiming

·       Validating travel time claims and applicable limits

·       Assessing non-labour travel costs

·       Managing travel claims across multiple participants

·       Preventing duplication and embedded travel charges

19. Activity Based Transport Claiming

·       Distinguishing ABT from provider travel

·       ABT claiming for participation-related supports

·       ABT claiming for capacity building supports

·       Common ABT item and unit mismatches

20. Short Notice Cancellations and Non-Attendance Claims

·       Eligibility conditions and notice period logic

·       Correct structuring of cancellation claims

·       Distinguishing cancellations from delivered supports

·       Managing participant concerns and disputes

21. Group-Based Supports and Programs of Support

·       Identifying group-based supports

·       Applying rate division requirements

·       Validating group size and attendance logic

·       Managing billing under programs of support

·       Preventing over-claiming and structural errors

22. Irregular Rosters and Time-of-Day Pricing Rules

·       Time and day classifications and their pricing impact

·       Claims crossing time or day boundaries

·       When invoice splitting is required

·       Minimum timing detail required on invoices

23. Regional, Remote, and Very Remote Pricing Arrangements

·       Location-based pricing rules and eligibility

·       Applying regional and remote loadings correctly

·       Evidence requirements for location-based claims

·       Common errors in applying loadings

24. Centre Capital Costs and Establishment Fees

·       Identifying allowable centre capital cost claims

·       Establishment fee eligibility and limitations

·       Correct invoice structuring for capital-related charges

·       Preventing incorrect or duplicated capital claims

25. Irregular SIL and High-Complexity SIL Claiming

·       Defining irregular SIL supports

·       Common billing risks in irregular roster arrangements

·       Validation and documentation requirements

·       Escalation triggers for high-risk SIL claims

26. Complex Claims Involving Multiple Workers or Activities

·       Multiple worker billing conditions

·       Shadow shifts and supervision claims

·       Case conferences and coordination activities

·       Preventing duplicated time-window billing

·       Escalation pathways for complex scenarios

27. Prohibited Charges and Non-Claimable Costs

·       Identifying prohibited fees and add-ons

·       Managing co-payments and gap fees

·       Preventing bundled non-claimable charges

·       Standardising responses to non-compliant invoices

28. Red Flags and Payment Integrity Risk Indicators

·       Mismatch between invoice descriptions and items

·       Duplicate claims across providers or time periods

·       Unsupported or vague charging patterns

·       Patterns likely to trigger integrity review

29. Professional Communication With Providers

·       Neutral, clear communication about pricing issues

·       Requesting specific corrections efficiently

·       Managing repeated non-compliance

·       Maintaining consistent messaging across the team

30. Internal Decision Notes and Audit Readiness

·       Recording defensible decision trails

·       Documenting complex claim reasoning

·       Maintaining consistency across staff

·       Reducing repayment and compliance risk

31. Standardising Invoice Checking Across Teams

·       Shared validation workflows and checklists

·       Use of templates and standard decision language

·       Reducing variation and second-guessing

·       Improving efficiency and turnaround times

32. Quality Controls and Governance Practices

·       Duplicate detection and reconciliation controls

·       Sampling and quality assurance checks

·       Escalation thresholds for high-risk claims

·       Continuous improvement through trend analysis

33. Managing Pricing Updates and Rule Changes

·       Tracking and interpreting pricing updates

·       Updating internal tools and references

·       Briefing staff efficiently on changes

·       Ensuring consistent adoption across the team

34. Building Confidence and Consistency in Pricing Decisions

·       Applying rules with clarity and assurance

·       Knowing when to escalate versus decide

·       Reducing reliance on informal advice

·       Improving participant experience through accurate billing

COURSE DURATION:

The typical duration of this course is approximately 4-5 hours to complete. Your enrolment is Valid for 12 Months. Start anytime and study at your own pace.

ASSESSMENT:

A simple 10-question true or false quiz with Unlimited Submission Attempts.

CERTIFICATION:

Upon course completion, you will receive a customised digital “Certificate of Completion”.