Claim Management

Learn about Claim Management Settings in Maica

Please note that this page is a work in progress. The current information about Claim Management Settings 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.

These settings determine how Maica manages Claiming and its function throughout the application. You can use the Claim Management settings to manage how Payment Requests will be provided to the NDIS for claim processing. For reference:

• API means Payment Requests will be automatically created and submitted to the NDIS for processing based on the Claim Frequency settings defined below and on the Invoice Entry component.

• BPR File means Payment Requests will be automatically created but not submitted to the NDIS for processing. In order to submit the Payment Request, you need to generate the Bulk Payment Request (BPR) File via the Generate Bulk Payment Request section below. You can then upload this file via the myplace provider portal.

  • These Payment Request records will be created with Status = BLANK

In addition, and before we dive into configuring your Claim Settings in Maica, please refer to the quick overview of Claim Behaviour between Claim Management Settings vs Invoice Entry Claim, as this can vary depending on where you are in Maica and hence is important to understand. To learn more, see the expandable dropdown below.

Claim Management Settings vs Invoice Entry Claim

Below describes a quick overview of Claim Behaviour between Claim Management Settings vs Invoice Entry Claim within Maica, as this can vary depending on where you are in Maica.

Claim Management - Maica Settings

The Claim Management settings in the Maica Settings tab define your organisation-wide default Claim Settings. These settings act as the default behaviour applied if no changes are made during Invoice Entry (explained below).

Claim Management - Invoice Entry

The Claim Behaviour dropdown in the Invoice component allows users to define how a specific Invoice should be claimed (as shown below). These settings are applied on an individual basis and affect only the Invoice being entered. Once the Invoice is submitted, the Claim Behaviour selection resets, ready for the next Invoice. If no Claim Behaviour is selected at the Invoice level, the Global Setting behaviour will apply.

Available Claiming Options

If your Claim Method is set to API, only the following values are available in the Invoice Entry component:

• Use Claim Settings

• Claim Immediately

• Do Not Claim

If your Claim Method is set to BPR File, only the following Claim Behaviour values are available in the Invoice Entry component:

• Claim via BPR File (default)

• Do Not Claim

Please refer to the below headings for more information on each setting:

Claim Method

The Claim Method Setting not only allows you to select the Method of Claiming, but also, the Claim Behaviour.

Firstly, for your Claim Method, you can select between API or BPR File (as explained above).

It is important that you do not toggle from BPR File to API with an open, or unfinished, claiming cycle. If you have generated Payment Request records with the Claim Method = BPR, these cannot be claimed via the API.

Then, you can select your Claim Behaviour from the following options:

A Claim Behaviour in Maica determines how Payment Requests are managed, created, and submitted to the NDIS for processing. It allows you to control the way claims are handled based on your organisation's workflow requirements.

Claim Behaviour	Description	Claim Method
Use Claim Settings	The default option that uses the Claim Frequency settings configured in Maica. Claims will be created and submitted based on these predefined rules. To learn more Claim Frequency, see below.	API
Claim Immediately	Payment Requests are created and submitted to the NDIS as soon as they are generated	API
Do Not Claim	Prevents a Payment Request from being submitted for claiming.	API, BPR
Claim via BPR File	Payment Requests are generated and included in a Bulk Payment Request (BPR) File, which can be manually uploaded to the myplace provider portal for processing.	BPR
Claim via HCP File	Payment Requests are generated and included in an HCP (Home Care Package) File, suitable for claims processed under the HCP framework.

Generate Bulk Payment Request (BPR) File

With Maica, you can generate a Bulk Payment Request (BPR) File and upload it directly to the myplace Provider Portal.

The BPR file allows you to submit multiple payment requests in a single upload, saving time compared to submitting individual requests for each Service Booking or Participant.

Once the Bulk Payment Request file is generated in Maica:

1. Log in to the myplace Provider Portal.

2. Navigate to the Bulk Payment Request Upload section.

3. Upload the file generated by Maica.

Maica ensures the file is fully compliant with the NDIS template, so you can confidently upload it without any manual adjustments.

Before you generate and use a Bulk Payment Request (BPR) File, it's important to understand the BPR process and its steps. The process consists of three sequential steps that must be completed in the order shown. These steps are outlined in the expandable box below.

Overview of the Bulk Payment Request (BPR) Process

Step 1: Bulk Payment Request (BPR) File

The Request File is the initial file generated in Maica (from Salesforce) that contains the Payment Request data you intend to submit to PRODA for processing. The below text details how to generate the Request File within Maica.

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Step 2: Bulk Payment Request Results (BPR) File

The Results File is downloaded from PRODA after uploading your Request File (Step 1). It contains the outcome (Success/Fail) for each Payment Request included in your submission.

Note: While the BPR Results File includes payment information, Maica does not use this file to update payment request statuses. Instead, the Remittance File (Step 3) is used for that purpose.

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Step 3: Bulk Payment Request Remittance (BPR) File

The Remittance File is downloaded from PRODA and contains the final payment results for each Payment Request included in your original upload (Step 1).

Now that you have an overview of the BPR process, continue to the section below to learn how to generate the Bulk Payment Request (BPR) File from Maica and Salesforce.

Generating a Bulk Payment Request (BPR) File

So, once you're in the Claim Management section of Maica Settings, generating the Bulk Payment Request (BPR) File is just a few clicks away.

Generate Bulk Payment Request in Maica Settings

Before you click Generate CSV button shown above, you’ll need to complete a one-time setup to enter your Registration Number. This is the number listed as your Organisation ID in your Provider Portal Profile. Input your Registration Number in the Registration Number field shown above.

Once done, apply the relevant filters:

1. Date Range

   • Note, the Date Range filter uses the Invoice Created Date. Maica will search for all Invoice records added to Salesforce within the Start Date and End Date specified.

2. Payment Request Status

   • You can filter by the following Payment Request Status values:

     • Blank

     • Failed

     • Incomplete

     • Cancelled

     • Rejected

We recommend always including the Blank value. This ensures all records within the selected Date Range that have not been included in a previous BPR file are captured. The other values (Failed, Incomplete, Cancelled, Rejected) allow you to retry or reclaim previously unsuccessful Payment Requests.

Then, use the Exclude option to specify Providers or Invoices you do not want included in the BPR File. Any items listed here will be excluded from the CSV file generated. The Exclude Section is shown below.

Once your filters are applied:

1. Maica will display a count of all Payment Request records that match your criteria.

2. Review the total displayed to confirm it meets your expectations.

3. Click Generate CSV, and Maica will handle the rest!

What Happens Next?

During the file generation process, Maica performs a series of important updates. For more information, refer to the Post BPR File Generation section below.

Please note, the myplace Provider Portal only supports up to 5000 rows in an uploaded BPR File, meaning, if your filter criteria returns a result set containing more than 5000 rows, Maica will present the error below and not allow you to complete the process. The following error will be displayed:

The results of the date range and status criteria selected exceeds 5000 records. Please adjust your criteria to refine the results.

BPR File Query Summary

How Does Maica Determine What to Include in the BPR File? Maica determines which Payment Request records to include in the BPR file based on the following criteria:

1. Payment Request Status

   • Only records matching the value(s) selected in the Status Filter will be included.

2. Invoice Created Date

   • Records with an Invoice Created Date that falls within the Start Date and End Date specified in the filters will be included.

For a more technical user:

SELECT Id FROM maica__Payment_Request__c 
WHERE DAY_ONLY(maica__Invoice_Line_Item__r.maica__Invoice__r.CreatedDate) >= :startDate
AND DAY_ONLY(maica__Invoice_Line_Item__r.maica__Invoice__r.CreatedDate) <= :endDate
AND maica__Status__c IN :selectedStatuses

For more details on applying these filters, see the section above.

Post BPR File Generation

Once the Bulk Payment Request (BPR) File has been generated, Maica performs specific actions to complete this first step in the BPR Claiming process. These actions are outlined below:

New Payment Request Created (Reclaimed Payment Requests)

When generating the BPR File, if the Status Filter included a value other than Blank, this indicates that a previous claim attempt has already been made—either through a BPR File or the API. In this case, a new Payment Request record is required to facilitate the new claim.

This is because PRODA requires each Payment Request to have a unique Claim Reference. A Payment Request can only be used once, so to attempt the claim again (a “reclaim”), Maica creates a new Payment Request record.

Here’s what happens:

• The previously attempted Payment Request record is cloned, and a new Payment Request record is created.

• The Status of the new record will be updated to Awaiting Approval, regardless of the previous status.

• The Status of the original (cloned) Payment Request record is updated to Resubmitted to reflect that it has been included in a new BPR File.

The Resubmitted Status value is only used when the Claim Method = BPR File.

Payment Request Updates - Field Updates

After the Bulk Payment Request (BPR) File is exported, Maica updates specific fields on the Payment Request records included in the file.

Payment Request Field	Value
Status	Awaiting Approval (detail below)
Claimed Amount	Invoice Line Item.Claim Balance
Claim Date	TODAY
NDIS Reference	Claim Reference Index (detail below)

Payment Request Updates - Status

To ensure that the Payment Request reflects its inclusion in the BPR File, Maica updates the Status of the Payment Request record(s) to Awaiting Approval.

The next update to the Payment Request Status will occur when the BPR Results File is imported.

Payment Request Update Claim Reference Index

As part of the BPR File export, Maica ensures consistency across fields by setting the NDIS Reference field to match the Claim Reference Index field.

This ensures that the NDIS Reference field is populated consistently, whether you are claiming via the API or the BPR File.

When claiming via the API, the Claim Reference is not used, as the NDIS does not require this value. Instead, PRODA returns an API Reference, which Maica populates in the NDIS Reference field.

BPR File Template Definition

Template Field Name	Information
RegistrationNumber	The Provider's registration number as entered in Maica Settings
NDISNumber	Participant's NDIS Number on the Contact
SupportsDeliveredFrom	Service Date on the Invoice Line Item
SupportsDeliveredTo	Service Date on the Invoice Line Item
SupportNumber	Support Item Number of the Product provided on the Invoice Line Item
ClaimReference	Claim Reference on the Invoice Line Item
Quantity	Quantity on the Invoice Line Item See note below for additional details.
Hours	Since Quantity is entered, this field is not required.
UnitPrice	Unit Price on the Invoice Line Item
GSTCode	GST Code on the Invoice Line Item GST as applicable to the item or service. P1 = Tax Claimable (10%) P2 = GST Free P5 = GST out of Scope
AuthorisedBy	Legacy field, can be left blank
ParticipantApproved	Legacy field, can be left blank
InKindFundingProgram	Not Applicable
ClaimType	Claim Type on the Invoice Line Item Claim type of the service provided - “(Blank)” – Direct Service. You must leave field blank. - CANC: Cancellation - REPW: NDIA Required Report - TRAN: Provider Travel - NF2F: Non-Face-to Face Services
CancellationReason	Cancellation Reason on the Invoice Line Item Reason of the cancellation type - NSDH: No show due to health reasons - NSDF: No show due to family issues - NSDT: No show due to unavailability of transport - NSDO: Other

Quantity Logic

In a reclaim scenario (e.g., an additional claiming attempt), the Quantity value populated in the BPR File may differ from the initial claiming attempt. The logic is summarised below:

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When the following condition is met:

• Payment Request.Claimed Amount > Invoice Line Item.Unit Price

Maica sets:

• BPR Quantity = Claimed Amount ÷ Unit Price

• BPR UnitPrice = Unit Price

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Otherwise, Maica sets:

• BPR Quantity = 1

• BPR UnitPrice = Claimed Amount

This ensures that the UnitPrice does not exceed the Price Book price, as this would result in rejection by PRODA.

Sample BPR File

Below shows a sample BPR File that has been generated.

For further assistance with processing bulk requests in the myplace Provider Portal once you have the BPR File, refer to this page or watch this video tutorial by the NDIS.