Claim an Invoice

Learn how to Claim via the NDIS when your Funding Type is Agency Managed in Maica

Please note that this page is a work in progress. The current information about Claiming an Invoice is accurate, but additional content will be added as it is documented. Please check back regularly for updates. If you have any questions or need assistance, feel free to contact our support team here.

How does Claiming an Invoice via the NDIS work on Maica?

There are two ways to claim an Invoice in Maica. These are:

1. API: Submitting claims directly to the NDIS through an automated, real-time system integrated with the myplace portal using secure authentication.

2. BPR File: Uploading a bulk file of claims to the myplace portal for batch processing, with results manually reviewed from a response file.

In Maica, you can select your Claim Method in the Claim Management Settings. Your Claim Method is usually set by your Organisations Administrator.

To learn more about selecting your Claim Method, click here.

Note, claiming only applies when the Funding Type is Agency Managed.

This article details the process of claiming via the API.

To learn how claiming works within Maica if your Claim Method is BPR File, click here.

Claiming an Invoice via the API

Maica has Automation for NDIS Claiming, meaning as a User, minimal manual input is required. However, the below information details what happens within Maica's Automation if your Claim Method is set to API.

Maica's claiming behaviour is dependant on not only your Claim Method Setting, but also your Claim Behaviour Setting.

To learn more about the different Claim Behaviour Settings, click here.

In this article, we will use a Claim Behaviour of Claim Immediately in order to detail the API process. Regardless of your Claim Behaviour, the actual claiming process will be identical to the process detailed below. This is because Maica dynamically updates the Claim Behaviour to Claim Immediately in order to trigger the the callout. For example, if your Claim Behaviour was set to Do Not Claim, meaning you need to use the manual Claim Quick Action, then when used, the Claim Behaviour will be set to Claim Immediately in that moment to run the process outlined below.

Please also note, this section only talks to the Claim process, the Remittance process is further detailed below. The diagram and information below details the process.

For clarity, any Italic text in the description or diagrams refers to an NDIS record, and any standard text refers to a record in Maica.

Stage	Description
Claim Executed	First, the Invoice Claim Behaviour (maica_cc__Claim_Behaviour__c) is set to Claim Immediately and a callout is made to the NDIS Payments API.
Retrieve Payment Requests	Then, Maica retrieves the relevant Payment Request records (field definition below) associated with the Invoice Line Items and sends this to the NDIS to create corresponding records. Note, when the claiming process is fully automated (via API), all valid Payment Request records are claimed.
Create Payment Request	The Payment Request is created via the API
Was the Request Successful?	The logic splits based on whether the Payment Request was successfully created in the NDIS system. Please note, this step does not determine whether your Claim has been successfully assessed for payment, but rather indicates the Payment Request record has been successfully created in the NDIS system
Update Payment Request (if No)	When No, there are two potential outcomes: Technical Issue: If the Payment Request record was not successfully saved in the NDIS system, Maica will update the status of the unsuccessful Payment Request to Failed Claim Issue: The Payment Request was assessed and the claim rejected by the NDIS. An example of this is insufficient budget. In this case, the Rejection Reason provided by the NDIS is returned to the Reject Reason pick list on the Payment Request for your review
Update Payment Request (if Yes)	The claim is assessed and approved for processing and key Payment Request fields are updated as per the table below
Process Ends	The claiming process is now complete, and you can wait for the Remittance update to be applied. Note, the Remittance update occurs when the corresponding Notification (Webhook) is triggered by PRODA. The timing of this notification is determined by PRODA, and Maica does not control when it is received. To learn more about the Remittance Notificaiton, see below.

Payment Request Callout API Mapping Table

The table below outlines how fields in the NDIS Payments API are mapped to the corresponding fields in Maica's Payment Request object. It shows how data flows between Maica and the NDIS API during Payment Request submissions.

Please note, some fields involve direct mappings (e.g., claimed_amount → Claimed_Amount__c), while others involve calculated values (e.g., quantity → Claimed_Amount__c / Invoice_Line_Item__r.Unit_Price__c).

NDIS Payments API	Payment Request object
ref_doc_no	Name
service_agreement	Invoice_Line_Item__r.Booking_Item__r.Service_Booking__r.NDIS_Reference__c
product_category_item	Invoice_Line_Item__r.Support_Item__r.Support_Item_Number__c
participant	Invoice_Line_Item__r.Invoice__r.Participant__r.NDIS_Number__c
claimed_amount	Claimed_Amount__c
quantity	Calculated: Claimed_Amount__c / Invoice_Line_Item__r.Unit_Price__c
tax_code	Invoice_Line_Item__r.GST_Code__c
claim_type	Invoice_Line_Item__r.Claim_Type__c
claim_reason	Invoice_Line_Item__r.Cancellation_Reason__c
start_date	Invoice_Line_Item__r.Service_Date__c
end_date	Invoice_Line_Item__r.Service_Date__c
unit_of_measure	Fixed value: 'EA'
abn_provider	Invoice_Line_Item__r.Invoice__r.Provider__r.ABN__c
abn_not_available	true if Invoice_Line_Item__r.Invoice__r.Provider__r.ABN__c = NULL

Payment Request Response API Mapping Table

This table outlines the response mapping between the NDIS Payments API and Maica's Payment Request object. It shows how key fields returned by the NDIS API are mapped to the corresponding fields in Maica.

NDIS Payments API	Payment Request object
claim_number	NDIS_Reference__c
claimed_amount	Claimed_Amount__c
claim_status	The Status value is mapped directly from the NDIS, and could be any of the following: Failed Resubmitted (BPR Only) Incomplete Awaiting Approval Pending Payment Cancelled Rejected Paid