Claim Management

For those of you who want to manually manage how Claims are generated and processed

The Claim Management component is a bit of a 'jack of all trades' when it comes to claiming and can be used to support a few important scenarios, such as:

• If you need to reclaim a failed Payment Request (API and BPR)

• If you wish to review your Invoices prior to claiming - you can use the Claim Management component to generate Payment Requests and submit these to PRODA via either the API or the BPR File process

Reclaiming

Whilst we would love to think otherwise, not all claiming attempts are successful and result in the funds being claimed and paid to your bank account. A Payment Request can be Rejected by the NDIS, i.e. service date is outside the active Service Booking, or you may experience a Failed Payment Request meaning that the claim has not been successfully submitted to the NDIS for processing, i.e. a technical issue with the API.

Examples of a Payment Request in Rejected and Failed Status can be seen below:

Example of a Rejected Payment Request

Example of a Filed Payment Request

Now, for some of the Rejected or Failed Payment Request records, this is the end of the line and no further action can be taken as the errors cannot be addressed and the claim cannot be processed.

For other unsuccessful claims, however, many of these can be reviewed by your team and the error(s) rectified in order to try the Payment Request again, or reclaim the funds. This is where the Claim Management component comes into the picture.

Once you have addressed the cause of the initial Reject Reason or Error provided on the Payment Request, the record is ready to be reclaimed. In order to this, simply navigate up to the Invoice the Payment Request is associated with (this is through the Invoice Line Item). Once you are at the Invoice level, click the Claim Quick Action to launch the current Invoice in the Claim Management component.

The Claim Quick Action on the Invoice record

From the Claim Management component, the key Invoice information is displayed at the top, whilst directly underneath, all applicable Invoice Line Item records are listed in a table-style format.

The logic as to what defines a valid or applicable Invoice Line Item is defined in the Rules and Validation section below.

The selected Invoice in the Claim Management component

Some base information is displayed for each Invoice Line Item, such as the Support Category and Support Item, however the most relevant for this reclaim scenario are:

• Claimed Amount

• Available Claim Amount

  • Represents the Claim Balance or the maximum value remaining that can be claimed

• Claim Amount

  • Use this to specify the amount you would like to claim in the attempt

  • Amount defaults to the Available Claim Balance but supports a lower value if desired

From here, confirm all the details are correct, i.e. ensure the Claim Amount reflects the appropriate value, check the confirm box and click Claim. What happens next changes based on your Claim Method defined under Claim Settings --> Maica Settings.

Reclaiming when Claim Method = API

If your claiming is managed via the API (Claim Method = API), then there is nothing left for you to do! The new Payment Request record(s) is created and submitted to PRODA for claiming immediately and the Invoice Claim Behaviour is set to Claim Attempted.

Reclaiming when Claim Method = BPR File

In this scenario, a new Payment Request record is generated (for your Claim Amount), however, it is not submitted for claiming automatically. The Payment Request is created with a BLANK Status, making it available to be picked up via the standard BPR File generation process.

Once the BPR File is generated (with the the newly created Payment Request record(s) included) the Invoice Claim Behaviour is set to Claim Attempted.

Success message when reclaiming via the BPR File

Invoice Review and Claim

If your claiming process involves a review or validation step, this would mean that your Invoice records are created in Salesforce with the Claim Behaviour set to either Under Review OR Do Not Claim (we would recommend Under Review).

For Invoice records in this state, no Payment Request record is created and therefore no claim is submitted (which is exactly what you would want so you could review and validate)!

Once you have reviewed the Invoice and are ready to claim, simply follow the steps described in this article and pay attention to the Reclaiming when Claim Method = BPR File section above as it describes how the Invoice and Payment Request the records are handled.

Rules and Validation

The Claim Management component, like many in Maica, enforces some base rules and logic that it is important for you to be aware of prior to using it.

Specifically, any Invoice Line Item record with an associated Payment Request record with one of the Status values below cannot be reclaimed. Maica considers Payment Request records with these Status values to be part of an active claim cycle, either API or BPR File, and we do not want the Claim Management component to generate a duplicate Payment Request erroneously.

• BLANK

• Awaiting Approval

• Pending Payment

Should you wish to include an Invoice record with such an existing Payment Request, you need to first cancel the Payment Request via the Cancel Quick Action on the Payment Request itself.