Claiming & billing: claimed vs delivered vs paid

In aged care, NDIS and Home Care Package work, every shift or service touches three separate numbers. Delivered is what your staff actually did — the hour of personal care, the transport, the support coordination logged in your rostering or care management system. Claimed is what you submitted to the funder (the NDIA via PRODA/PACE, Services Australia, or a plan manager). Paid is the money that finally lands in your bank account.

In a perfectly run business these three would be identical. In reality they drift apart constantly. A carer delivers 90 minutes of support but the claim goes in for 60. A claim is submitted but rejected because the participant's plan ran out of funds. A payment arrives but is short by 15% because the wrong price guide line item was used. Each gap is real money — and at mid-market scale (say 200+ participants), small leaks add up to tens of thousands of dollars a year.

The reason this matters so much in your sector is that you carry the cost of delivery upfront. Your staff are paid for the hour they worked regardless of whether the claim succeeds. So a delivered-but-never-paid service isn't just lost revenue — it's a direct loss, because you've already paid the wage.

Most billing leakage isn't fraud or laziness — it's friction between systems that don't talk to each other. Your rostering tool knows a shift happened. Your care management or claiming system decides what gets submitted. Your accounting software records what was paid. When a carer adds a 20-minute extension on-site, or a visit gets cancelled at the door, that information often never flows cleanly from one system to the next.

NDIS work adds specific traps. Claims fail when a participant's funding category is exhausted, when the service date falls outside their plan dates, or when the line item and price don't match the current NDIS Price Arrangements. Home Care Packages have their own version: services delivered against a package that's already fully committed, or against the wrong subsidy level. Each rejection often comes back days or weeks later, by which time the original context is hard to reconstruct.

The other quiet source of loss is the un-claimed delivered service — work that was genuinely done but never made it into a claim batch at all. Because nothing was submitted, nothing was rejected, so nothing flags it. It simply never appears as revenue. These are the hardest gaps to find precisely because the systems are all individually "correct" — the breakdown is in the spaces between them.

The practical fix is reconciliation: regularly comparing delivered, claimed and paid for every service, and chasing down anything that doesn't line up. The goal is to answer three questions on demand. What did we deliver that we never claimed? What did we claim that was rejected or short-paid? And how long is money sitting between delivery and payment?

A concrete example: a 180-participant NDIS provider runs a weekly check. They match each completed shift in their rostering system to a claim line, and each claim line to a payment in their accounts. One week they find 14 delivered hours of support coordination that were never claimed (around $1,900), plus six claims rejected for expired plan dates (around $700). Found early, the un-claimed hours can still be submitted and the rejected ones re-worked with the participant's updated plan. Found three months later, much of it is gone for good.

Doing this by hand across three or four disconnected systems is slow and error-prone, which is exactly why so many providers don't do it consistently. When delivery, claiming and payment data sit together in one unified place, the matching can run automatically and surface only the exceptions that need a human. Your practical takeaway: pick one service type, reconcile delivered-vs-claimed-vs-paid for the last month, and put a dollar figure on the gap — that single number is usually enough to justify making this a routine, not a one-off.