NDIA Review Process

The National Disability Insurance Agency (NDIA) has just recently begun scrutinising the supports that individuals use to ensure that they are adequate and appropriate for their circumstances.

Why should we care about this?

If the NDIA determines that a support you have been using isn’t reasonable and necessary, you might be required to pay for it using your own personal funds if they make that decision. Because the NDIA looks at your entire history of support rather than evaluating each claim as it is submitted, you may be responsible for paying a significant portion of your own medical expenses.

What actions you can take

We strongly advise performing a speedy audit of your supports to determine whether or not they satisfy the criteria of being reasonable and essential before you find yourself in a financial bind. In our experience, the following are some of the most common factors that lead to the NDIA declining to provide support:

  • It is something that people use on a regular basis.
  • It is possible for another type of assistance programme, such as Medicare, to pay for it.
  • There is a more cost-effective substitute that is capable of performing the same function.

If you are still of the opinion that a particular support would be of benefit to you and that it should be funded by the NDIS, but you are concerned that the NDIA might not agree with you, obtaining a formal letter of support from an allied health professional can be of assistance. A certain number of supports call for the presentation of some evidence in order to be accepted. For instance, if the NDIS makes it clear that it does not provide funding for a particular item or service – like white goods, for instance – you will need to get a LAC or planner to give their stamp of approval.

What can we do to assist?

At Careable, we are well-versed in all aspects of the NDIS, including its plans and funding. We collaborate with you to investigate any and all possibilities so that you can make the most of your plan. It’s possible that there are forms of assistance that you haven’t looked into yet, or that there is a more innovative approach to funding support that you are unaware of. Get in touch with us right away to acquire additional information regarding our support coordination and plan management services.

If you are a Careable customer and have concerns about whether or not the NDIA will consider the supports you receive to be reasonable and necessary, our team will walk you through the checklist of what the NDIA considers to be reasonable and necessary and look at how you can achieve your possible. Get in touch with me right away.

The method we use for our internal reviews.

To protect our clients from unnecessary audits, we investigate each and every reimbursement claim that comes through our doors. If we believe that the NDIA will have a problem with any of your supports, we will let you know about it and look into alternative options that are compatible with your plan.

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