Open Claims Configuration
From the left navigation menu, click Admin.
At the top of the Admin page, click Configuration.
In the left-side configuration menu, click Invoicing, then select Claims.
This opens the Claims Config page.
Choose the Pre-claim Validation Mode
The Pre-claim validation section controls what happens when a claim does not meet required checks before submission.
Choose an Enforcement mode:
Off
No pre-claim checks are run. Claims can be submitted as-is.Warn
The system shows warnings for failed checks but still allows the claim to be submitted.Block
The system prevents claims from being submitted when required checks fail.
Select the mode that matches how strict your organisation wants the claim submission process to be.
Turn On Required Checks
Under Required Checks, use the toggles to select which checks should apply before a claim is submitted.
Available checks include:
Require an active plan
Blocks submission when the interaction date falls outside an approved plan.Require consent on file
Blocks submission when there is no consent record for the participant.Require signed service agreement
Applies when the Service Agreements feature is enabled.Require correct weekend / PH rate
Refuses a weekday rate code on a Saturday, Sunday, or public holiday.Auto-suggest correct rate
Suggests the correct code when a rate appears incorrect.
Click Save after updating these settings.
Use Reset to default if you need to restore the default configuration.
Add Evidence Requirements
The Evidence requirements section lets you add item codes that must have an evidence file attached before a claim can be submitted.
Enter the item code in the Item Codes Requiring Evidence field.
Example:
01_011_0107_1_1
Then click Add or press Enter.
Item codes must match exactly against ndis_service_item.itemNumber.
Click Save after adding or updating evidence requirements.
Set the Claim Approval Threshold
The Claim approval threshold section controls when a claim requires manager approval before submission.
Enter the dollar amount in the Approval Threshold field.
Claims above this amount will require approval before they can be submitted.
To disable this requirement, set the amount to 0.
Click Save after updating the threshold.
Set the Resubmission Window
The Resubmission window section controls the maximum age of an interaction that can still be resubmitted on a corrected claim.
Enter the maximum age in days.
In the example shown, the value is 90 days.
The NDIA cap is 90 days, so your organisation can make this stricter but cannot loosen it beyond the allowed cap.
Click Save after updating the resubmission window.
Set the Default Cancellation Reason
The Default cancellation reason section controls the cancellation code that is pre-selected when a coordinator marks an interaction as cancelled.
Use the Default Reason dropdown to choose the default cancellation reason.
In the example shown, the selected reason is:
NSDH, No Show, Did not Honour
Coordinators can still choose a different cancellation code per interaction if needed.
Click Save after updating the default reason.
Important Notes
Off allows claims to submit without pre-claim checks.
Warn shows warnings but still allows submission.
Block prevents submission when required checks fail.
Evidence requirements only apply to exact item code matches.
The approval threshold applies before claim submission.
The resubmission window should align with NDIA rules and your organisation’s internal process.
Each section has its own Save button.
Click Save in the section you changed before leaving the page.
Troubleshooting
If claim validation is not working as expected:
Check the selected Enforcement mode.
Confirm the required check is turned on.
Make sure you clicked Save after updating the section.
If claims are being blocked:
Check whether the participant has an active plan.
Check whether consent is on file.
Check whether a signed service agreement is required.
Check whether the correct weekend or public holiday rate is being used.
If evidence is still required after attaching a file:
Confirm the item code matches exactly.
Check that the evidence file is attached to the correct claim or interaction.
Refresh the page and try again.
If a claim needs approval unexpectedly:
Review the Claim approval threshold.
Check the claim amount.
Set the threshold to 0 if approval should not be required.
If a claim cannot be resubmitted:
Check the Maximum Age in the resubmission window.
Confirm the interaction is within the allowed number of days.
Remember that the NDIA cap is 90 days.