If your finance team has started seeing rejections linked to “my provider” under the new system, the issue is rarely about pricing, service quality, or documentation.
In most cases, the support was delivered correctly. The invoice is compliant. The service agreement is signed.
The breakdown happens inside the system used by the National Disability Insurance Agency (NDIA), where provider relationships must now be formally recorded before certain claims can be paid.
Under the National Disability Insurance Scheme (NDIS) PACE system, payment is no longer driven primarily by what you upload. It is driven by what is pre-authorised and structurally linked inside the participant’s plan.
This article explains the following:
- What “my provider” actually means in PACE
- Why valid claims are being rejected
- Where providers are making preventable mistakes
- How to redesign onboarding to stop payment blocks
Recommended Reads
- Budgeting Resources: Expand Your NDIS Financial Knowledge
- Claiming Strategy: Essential Reading for Long-Term Revenue
- Price Compliance: More Tips for Successful NDIS Invoicing
- Revenue Optimization: Master Your NDIS Add-On Claims
- AI Integration: Smarter Insights for NDIS Providers
- Dispute Resolution: Further Guides to Protect Your Business
What “My Provider” Really Means in PACE
In the previous system, many providers relied on service agreements and funding availability as practical authority to deliver and claim.
PACE operates differently.
When a participant records an organisation as their my provider, the system creates a formal relationship inside the NDIA platform. This relationship includes:
- The provider’s organisation details
- The relevant support category
- A start date (and sometimes review parameters)
- Permission for claims to be processed without additional confirmation
This is not symbolic. It is functional.
If the relationship does not exist in the system at the correct category level, the system does not recognise you as authorised, even if you have full written consent outside it.
That distinction is where most rejected claims originate.
Why a Signed Service Agreement is No Longer Enough
This is where providers need to adjust their thinking.
A service agreement:
- Confirms commercial intent
- Sets service terms
- Satisfies audit requirements
But it does not automatically create a system relationship in PACE.
PACE separates:
- Contractual agreement (your document), and
- Claim authority (system-recorded provider relationship).
If number two is missing, the system blocks payment, regardless of how complete number one is.
You can be compliant on paper and still be unclaimable in practice.
When “My Provider” is Mandatory
Not all supports require a “my provider” relationship. But for specific categories, it is non-negotiable.
Participants are required to record providers as “my provider” when funding includes:
- Specialist Disability Accommodation (SDA)
- Home and living supports
- Behaviour support
- Plan management services
For SDA, home and living, and behaviour support in particular, claims will be automatically rejected if the provider is not recorded at the relevant support category level.
This is not a manual review decision. It is system logic.
Additionally, where funding is NDIA-managed (agency-managed), recording a provider relationship may also be required depending on the support type.
The key operational mistake providers make is assuming that funding availability equals claimability. Under PACE, that assumption is unsafe.
The Most Common Rejection Scenario
Let’s look at what is happening on the ground.
- A participant transitions to a PACE plan.
- The provider continues or begins delivering home and living or behaviour supports.
- Claims are submitted normally.
- The system rejects the claim with a “my provider” related reason code.
Finance is confused because:
- Services were delivered correctly.
- The participant expects payment to go through.
- Nothing appears wrong on the invoice.
The root cause is almost always this:
The provider was never recorded as “my provider” at the support category level inside the participant’s PACE plan.
This is an onboarding failure, not a billing error.
Why NDIA Structured It This Way
From a control perspective, the NDIA has strengthened participant consent and visibility.
Recording a provider as “my provider” tells the system:
- The participant has explicitly authorised this organisation to claim
- NDIA does not need further validation before releasing funds
It is effectively a pre-approved claim pathway.
If that pathway does not exist, the system cannot release funds. It blocks the claim by design.
You may not like that design, but you must build processes around it.
How to Check Whether You’re Properly Recorded
Before the first claim submission, providers should verify their status in the my NDIS provider portal.
Specifically, check:
- Provider roles attached to the participant
- Support category allocation
- Whether your organisation appears as “my provider”
- Whether the start date aligns with your service commencement
This takes minutes and can prevent weeks of cash flow delay.
If your team is not doing this as a standard intake step, you are operating reactively.
The Hidden Risk: Funding Type + Support Category
Another structural weakness in many onboarding workflows is incomplete plan analysis.
You must confirm:
- Is the participant on a PACE plan?
- Is the funding NDIA-managed, plan-managed, or self-managed?
- Which support categories are you delivering against?
“My provider” requirements often apply based on a combination of:
- The type of support
- The funding management method
If your intake process captures only funding totals without analysing management type and category-level requirements, you are exposed.
This is where experienced providers differentiate themselves from struggling ones, in how thoroughly they read plans.
A More Mature Onboarding Structure
Instead of treating “my provider” as an admin afterthought, build it into a formal gate.
A strong PACE-ready intake checklist should include:
-
Plan Context Review
- Confirm PACE status
- Confirm funding management type per category
- Confirm relevant support categories
-
Relationship Requirement Assessment
- Are we delivering SDA, home and living, behaviour support, or plan management?
- Does this category require “my provider” recording?
-
Portal Verification
- Confirm provider relationship is recorded
- Check category-level accuracy
- Confirm effective date
-
Documentation
- Record date of verification
- Capture screenshot or confirmation note
- Store alongside service agreement
-
Delivery Control
- Do not submit first claim until verification is complete
- Where possible, avoid commencing high-risk supports without confirmation
This is not bureaucracy. It is cash flow protection.
How to Help Participants Record You Correctly
Participants are responsible for recording providers, but providers can reduce friction.
Keep communication simple and precise. Avoid overwhelming explanations.
Provide:
- Your registered organisation name exactly as it appears in NDIA records
- The specific support category
- A short explanation of why it is required
- Step-by-step instructions if needed
For example, clarify that without being recorded as “my provider,” the system will automatically reject claims for certain supports.
Most participants will act quickly once they understand that payment depends on it.
What creates delay is vague instruction.
If a Claim Has Already Been Rejected
If you discover the issue after submission:
- Confirm the provider relationship has now been recorded correctly.
- Review the original claim details for alignment with the correct category.
- Re-submit once confirmation is complete.
The Strategic Shift Providers Must Make
PACE is not simply a technology update. It enforces structural compliance at system level.
The system pays what is authorised inside it, not what is logically justified outside it.
If your intake process:
- Does not verify PACE status
- Does not assess funding type per category
- Does not confirm “my provider” relationships
- Does not block first invoices pending verification
Then your organisation is exposed to avoidable rejections.
Strong providers treat “my provider NDIS” as a compliance checkpoint, not an optional admin step.
Fix the structure at intake, and the majority of claim rejections disappear before they ever reach your finance team.
