FOI 24.25 1346 Document Disclosure Log.pdf

DOCUMENT1
DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS
FOi 24/25-1346
1. The number of NDJS service providers that have been placed on
manual payment processing by the ND/A within the last two
financial years (or the most recent available timeframe), presented
as a deidentified list by state.
2. The dollar amount reviewed under manual payment processing
for each provider during this period, presented in the same
deidentified list b state.
Response 1:
Financial Year
Number of Providers placed on MPR
2023/24
770
2024/25
1650**
**MPR team was stood up in early 2024, hence why there is a large variance in total
between FY23/24 and 24/25.
**Figures are approximate as at early May 2025.
**Whilst every effort has been made to ensure accuracy, this figure is approximate due to
potential limitations in data quality.
**Payment Integrity team are currently liaising with the NOIA Analytics, Data and Actuarial
(ADA) Division to assist in the management of data issues due to a breakdown of reporting.
Response 2:
Financial
Number of MPR
Number of MPR claims
Total dollar of MPR reviews
Year
applied
reviewed
2023/24
770
1024
$900,600
2024/25
1650**
�.956
$35,798,668.41
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DOCUMENT 2
DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard Operating Procedure
National Disability Insurance Scheme
Standard Operating Procedure
Payment Integrity Review Team:
• Request for Information
• Analysis of Evidence
• Case Finalisation
Version 1.0
Released 24/10/2024
1
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
Table of Contents
Purpose: ................................................................................................................................ 3
To be used by ........................................................................................................................ 3
Prerequisite checklist ............................................................................................................. 3
Timeline for claim review process .......................................................................................... 3
Testing Tool ........................................................................................................................... 4
Case Tracker Tab .................................................................................................................. 4
Phase 1 – Claims allocation and Request for Information .............................................. 4
Creating a SharePoint Case Folder ....................................................................................... 5
Day 1 .............................................................................................................................. 6
Plan Manager Courtesy Email ............................................................................................ 6
Request For Information (RTP) Letter ................................................................................ 7
Phase 2 – Monitor Payment Integrity inbox for response ............................................... 9
Phase 3 – Begin quality analysis process within the Testing tool ................................. 10
Phase 4 – QA Tracker with relevant links to information .............................................. 11
Phase 5 – Send Invitation to Comment letter to the Legal Team and Provider for all
adverse decisions. ........................................................................................................ 11
Phase 6 – Review of evidence ..................................................................................... 13
Phase 7 – Send Outcome letter to the provider and move to completed ...................... 14
Version change control ........................................................................................................ 17
2
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
Daily Testing of Provider Plan Manager Claims
selected for Review
Purpose:
The purpose of this Standard Operating Procedure (SOP) is to provide Case Officers with
guidance on the correct process to follow when a claim has been submitted by a Participant,
Provider/ Plan Manager who is subject to a manual payment review.
Case Officers will be responsible for:
• Creating a testing tool to review claims that meet the criteria.
• Reviewing the claim/s
• Contacting a provider primary contact
• Resolving the claim enquiry
• Communicating the outcome to the provider primary contact
• Documenting claim review
To be used by
• Payments Integrity Case Officers (CO’s)
Prerequisite checklist
• The authorised team member (APS6 or above) has applied a Manual Payment Review
to the claim based on the approved criteria.
• The APS6 has added the requested claims to the Testing Tool tab of the Case Tracker
Timeline for claim review process
Phase 1
Claims allocation and Request for Information
Phase 2
Monitor Payment Integrity inbox for response
Phase 3
Begin quality analysis process within the Testing tool
Phase 4
QA Tracker with relevant links to information
Phase 5
Send Outcome letter to the provider and move to completed
3
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DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS
Standard Operating  Procedure
Testing Tool
The Testing Tool is where a Case Officer will complete the review of any claims allocated to
them.  They will answer questions relevant to the review and based upon the answers to these
questions will determine the outcome of the review.
Case Tracker Tab
The Case Tracker tab will be used by Team Leaders to monitor the progression of their team's
cases and to record when correspondence and communication is made with the Participant,
Provider  or  Plan  manager.  The  case  number column  has  a  formula  that  aligns  the  case
number allocated to the claimls in the testing tab and summarises that information into one
case.
Phase 1  - Claims allocation and Request for Information
1. The  Team  Leader  (TL)  is  required  to  navigate  to  the  Case  Trackers  in our  Payment
Integrity Folders in SharePoint.
Documents  >  Payments Integrity  >  Payment Lock Referral
D  Name  v
0. Case Trackers  I
1. RTP Cases
2. Webform Referrals
2. Select your TL Case Tracker and open (open in the desktop app).
3. In the Claims Tab under the Case Status section, filter all 'Not started -Assigned'.
Case Status
a
4. In the Case column, filter for the relevant RTP number.
4
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
Creating a SharePoint Case Folder
1. A SharePoint case folder is created using the Project Name to store any correspondence
sent or received relevant to the claim review.
2. Navigate to the RTP Cases folder in SharePoint.
3. Navigate to the In Progress folder
4. Right click on the 02_RTP0000 – Draft Folder and select copy to; navigate to the relevant
Project name folder and copy here.
5. Refer to your case tracker to obtain the Case Project Name.
6. Right click on the folder, select Rename and overwrite the folder name with RTP
number assigned.
5
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
7. Any correspondence received or sent will be saved in the 1. Emails folder.
8. All PDF versions of correspondence will be saved in the 2. Letters folder.
9. Navigate to the 3. Claims Review folder, select Rename and overwrite the name with the
assigned RTP case number.
10. Open the RTP – Testing Tool spreadsheet (open in desktop app).
11. Copy and Paste the claims information from your individual case tracker across to the
Testing Tool tab of the RTP – Testing Tool spreadsheet starting at the Document Number
column. (paste as values).
12. This will transfer to the RTP0000 – Claim Review tab within the Testing Tool.
13. Rename  both  the  RTP0000  –  Claim  Review  and  RTP0000  –  Outcome  tab  with  the
assigned RTP number.
Day 1
Plan Manager Courtesy Email
1. After  the  initial  checks  have  been  completed  in  the  Testing  Tool,  we  then  proceed  to
sending out the first letter.
2. Navigate to the Templates folder, then to the Request for Information Templates folder
and download a copy of the PMA – Notification of payments on hold.msg template.
6
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DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS
Standard Operating  Procedure
3. To locate the Plan  Manager,  navigate to Testing Tool tab, in column  G you will find the
plan manager information
G
Received from BP Name
a
4. If the plan manager name if different to the Review Entity Name in column D, you will need
to send the PMA notification email.
5. You will need to send a copy of the relevant claims to the plan manager via email. To do
this navigate to the Testing tool tab,  copy all relevant claims from the Posting Date and
PRN fields and paste into the email template.
L
Date Submitted  Payment Reference Number
Posting
PRN
Date  a  a
6. Complete the missing sections in the email template using the contact information located
in SAP CRM/PACE.
7. Select the paymentsintegrityreview mailbox in the FROM section on the email if not
already selected.
r--;-i I  I
From  ....,
7E(d) - certain operations of agencies
�I  I
To
---------
8. Address the email to the contact listed above, proofread before hitting SEND.
9. Save a copy of the email in the 1. Emails folder and drag the email from your SENT box
to the Provider folder in the group mailbox.
Request For Information (RTP} Letter
1. Navigate to the 2.  Letters folder of the RTP folder previously created and right click on
the RTPOXXX Request for Information template and rename, saving using the assigned
RTP number under naming convention RTP - Request for Information.
�  RTP0708 - Request for lnformation.docx
�  RTP0708 - Request for lnformation.pdf
2. To  locate  the  email  address  of  the  Review  Entity,  navigate  to  SAP  CRM/PACE  and
search using the provider number found in column C of the Testing tool tab.
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
3. Open the letter and copy their email address from SAP CRM/PACE into the template.
Complete  the  rest  of  the  blanks  in  the  letter  by  referencing  the  Testing  Tool  tab.  The
return date for the RTP is a minimum of 14 days from the date of the letter (inclusive of
weekends).
4. Once complete, save the letter to PDF and save to the RTP folder created under the 2.
Letters Folder (same naming convention as word version).
5. Navigate to your Testing Tool and open the RTP – Claim Review tab. Highlight all claims
starting from row 1.
6. To change to PDF click File, Print. Ensure you select and change the  scaling to ‘Fit All
Columns on One Page’.
7. Click Print then Create PDF/XPS Document
8. Save to the RTP folder previously created under 2. Letters.
9. Navigate to the Templates folder, then to the Request for Information Templates folder,
right click and download the SP – Request for Information email template and paste the
primary  contact  and/or  Account  Manager  email  address  into  the  Good
morning/afternoon field.
10. Ensure PaymentsIntegrityReview is selected in the From field.
8
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DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS
Standard Operating  Procedure
r--;-i I  I
From  "
s47E(d) - ce  ain opera
�I  I
To
11. Attach  the  approved  PDF  RTP-Request  for  Information  letter  and  the  PDF  Claims
Review to the email.  Proofread the email before hitting send.
12. Save  a  copy of the email  in  the  RTP  folder  under  1.  Emails  by holding and  dragging
across from Sent, repeat this process dragging from the Sent Folder to Provider Folder
in group mailbox.
13. Go  to  your  Case  Tracker  and  update  the  Case  Status  column  select  In  Progress -
Waiting for provider.  Update the Support Provider - RFI column to reflect the date the
Request for Information  Letter was sent as well as the PMA Review Notice column to
reflect  notice  letter  being  sent  (if  applicable).  This  will  automate  the  Case  Due  Date
column to reflect a minimum of 14 days from today's date.
14. If  you  receive  an  email  with  documentation  from  the  provider  - refer  to  Evidence
Received section.
Phase 2 - Monitor Payment Integrity inbox for response
1. Your  Team  Leader  will  monitor  the  Payment  Integrity  Review  inbox  for  all
correspondence  from  the  PMA  and  Support  Provider  and/or  Participants  and
Nominees.
2. If you  receive an email,  please action accordingly.  Once you have actioned you  will
need to move both the received and sent emails into the Provider Folder located in
the group mailbox.
If at any stage throughout the process you receive documentation from the provider such as
an  invoice or  a receipt,  your Team  Leader will move these to the relevant  provider folder
within the group mailbox.  Note:  If the Participant,  Provider or Plan Manager has responded
to  the  notification  or  request  for  information,  ensure  you  provide  a  response  in  a  timely
manner. Seek Team Leader assistance if you are unsure on how to respond.
9
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
Phase 3 – Begin quality analysis process within the Testing tool
s47E(d) - certain operations of agencies
10
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
Phase 4 – QA Tracker with relevant links to information
1. Navigate to 2. Letters folder within the RTP folder previously created and right click
on the relevant Outcome Notice document, open in app.
2. Complete the blank fields in the letter.
3. Navigate to 6. QA and Cancellation Tracker, right click and open in app.
4. On the QA Log tab, enter the relevant data for Date, Case Number, Case Officer
Name, Support Provider ID, Support Provider Name, and Project Name.
5. Copy the Testing Tool link and paste under column G under Testing Tool, copy the
Outcome Notice letter link and paste under column H under Finalisation Letter.
6. Navigate to your Individual case tracker, filter for the relevant RTP number, update
the Case Status to ‘In Progress - Ready for QA claims review’.
Phase 5 – Send Invitation to Comment letter to the Legal Team and
Provider for all adverse decisions.
1. Once QA is complete and Justifications have been updated, for all adverse decisions
you will need to draft an Invitation to comment letter.
2. Please use the template located in the Templates folder.
3. Reach out to your Team Leader or EL for related Tip Off information to include in your
draft letter – please do not summarise this yourself, paste in exact and Legal will work
with you to reword this information.
4. Please highlight the tip off in yellow in your draft letter and add a comment asking for
assistance in re-wording.
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DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS
Standard Operating  Procedure
5. Navigate to the outcome tab of your testing tool and update the outcome and reasons
accordingly.
s47E(d) - certain opera ·ons of agencie
I
I
Testing tool
RTP2556 - Claim Review
RTP2556 - Outcome
Data Validation
2
3
4
5
6
6. Once you have completed the Outcome Tab you will need to change to PDF.
7. Highlight from A 1 through to F1 and then down to the bottom of the listed claims
8. To change to PDF click File, Print.  Ensure you select and change the  scaling to 'Fit
All Columns on One Page' and Change document to Landscape Orientation.
Settings
�  PrintActiveSheets
"'
i;t:±1  Only print the active sheets
I
Pages:
[IJ  Collated
l
.
1,2,3  1,2,3  1,2,3
I �  Port,ait Orientation
I. □ A4 21 cm x 29.7 cm
fFfl  Normal Ma1gins
l:ld:I  Top: 1.91 cm Bottom: 1.91 c .. ,
f"I  NoScaling
-rod
Print sheets at their actual size
Page Setup
9. Click Print then Create PDF/XPS Document
B
Create a PDF/XPS Document
Create PDF /XPS Document
•  Pr�e� layout,. fomutting, fontc;, and images
•  Content can't be easily changed
�  Change File Type
•  Free v1ewert are available on the web
Create.
PDF/XPS
10. Save to the relevant RTP folder.
11 . Once complete you will need to send both the draft letter and the Attachment A to the
Team Leader for review.
12. Once your Team Leader is satisfied with your letter they will forward to the EL for QA.
12
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
13. Once the EL has signed off you will need to send this through to the Legal Team along
with an Attachment A – this contains the preliminary decisions and justifications for
review.
14. The Legal team will review both the letter and Attachment A to ensure decisions are
correct and articulated well. Comments will be placed on the letter and sent back once
complete.
15. Once you receive feedback from the Legal team, please ensure you action all
comments and make the necessary changes.
16. Once complete you will need to send this back to Legal for their second review.
17. This process will go back and forth until Legal are satisfied with the letter and decisions
and will then give you the approval for the letter to be sent to the provider.
18. Once you have sent the letter to the provider please update the status in the QA tracker
to state “PF Letter sent to Provider”
Phase 6 – Review of evidence
Release/Substantiated/Compliant
s47E(d) - certain operations of agencies
13
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
s47E(d) - certain operations of agencies
Phase 7 – Send Outcome letter to the provider and move to completed
1. Once QA process has been completed and payment has been actioned, the TL will
notify you that it is ok to proceed. Navigate to the previously created RTP folder and to
2. Letters.
2. Open and amend the Outcome Notice letter then save as PDF.
3. Navigate to 3. Claims Review, open to the Testing tool, right click and open in app.
4. On the RTP – Outcome tab, amend any outcomes needed as a result of the QA
process, then highlight all claims including the banner data in row 1 to print to PDF.
5. To change to PDF click File, Print. Ensure you select and change the scaling to ‘Fit
All Columns on One Page’ and Change document to Landscape Orientation.
14
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DISCLOSURE LOG - FOI 24/25-1346 - DOCUMENT S
Standard
Standard Operating
Operating Procedure
Procedure
6. Click Print then Create PDF/XPS Document
7. Save to the RTP folder previously created under 2. Letters.
8. Navigate to the Templates folder, then to the Finalisation of Review Templates
folder, download the Finalisation of Review email.
9. Fill in the required fields within the email. Attach both the Outcome letter PDF and the
Claims Outcome PDF to the letter and press send.
10. Drag the sent email into the 1. Emails folder within the previously created RTP folder.
11. Update your individual Case Tracker with the Date closed, Support Provider –
Outcome Notice, and PMA – Outcome Notice (if applicable).
12. Change the Case Status to the relevant Closed drop down and update the Cancellation
Reason.
15
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DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS
Standard Operating  Procedure
:s47E(d) - certain operations of agencies
13. Once the case is updated to  closed these figures will then appear in the stats section
of the Case Summary tab.
14. Drag the RTP folder into the Completed Folder in SharePoint.
{j
Name  v
Completed
In Progress
Note:  When adding comments in either the testing tab or case tracker tab, please ensure
the most current comment is at the top of the cell.  Press ALT and ENTER to enter down a
line.
16
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DISCLOSURE LOG - FOi 24/25-1346 - DOCUMENTS
Standard Operating Procedure
Version change control
Version Amended by Brief Description of Change:
Status
Date
No
1
EJW188
Developed Work Instruction
Approved
�4/10/2024
2
EJW188
Updated to reflect changes to
Approved
6/11/2024
process
3
EJW188
Updated to reflect changes to
14/4/25
process
17
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