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:
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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:
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.
This is where providers need to adjust their thinking.
A service agreement:
But it does not automatically create a system relationship in PACE.
PACE separates:
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.
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:
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.
Let’s look at what is happening on the ground.
Finance is confused because:
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.
From a control perspective, the NDIA has strengthened participant consent and visibility.
Recording a provider as “my provider” tells the system:
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.
Before the first claim submission, providers should verify their status in the my NDIS provider portal.
Specifically, check:
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.
Another structural weakness in many onboarding workflows is incomplete plan analysis.
You must confirm:
“My provider” requirements often apply based on a combination of:
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.
Instead of treating “my provider” as an admin afterthought, build it into a formal gate.
A strong PACE-ready intake checklist should include:
This is not bureaucracy. It is cash flow protection.
Participants are responsible for recording providers, but providers can reduce friction.
Keep communication simple and precise. Avoid overwhelming explanations.
Provide:
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 you discover the issue after submission:
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:
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.