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Funding Sources

Configure your practice's funding sources to enable claiming and billing for Medicare, DVA, NDIS, and other payers.

Overview​

Funding sources are configured at two levels:

LevelPurposeLocation
OrganisationPractice-wide credentials and settingsSettings → Billing → Medicare (and per funding type below)
ClientIndividual client details (Medicare number, etc.)Client Profile → Funding Sources

This page covers organisation-level configuration. For client-level setup, see Practitioners: Funding Sources.

Medicare​

Prerequisites​

To enable Medicare claiming, you need:

  • PRODA account - Provider Digital Access (register at servicesaustralia.gov.au)
  • HW027 form - the Medicare Online Claiming agreement lodged with Services Australia, linking your provider numbers and practice location to Praxi as your claiming software
  • PRODA Organisation RA number - Your practice's PRODA organisation identifier
  • Location ID - Registered practice location with Services Australia
  • Provider numbers - Individual provider numbers for each claiming practitioner
warning

PRODA device keys: Praxi uses PRODA B2B device authentication with RSA key pairs. Device keys are rotated automatically, but you should monitor the key health status in Settings > Billing > Medicare. An alert is raised after repeated authentication failures and claiming is blocked to prevent device lockout. See the PRODA Setup guide for recovery steps.

Setting Up Medicare​

  1. Go to Settings → Billing → Medicare
  2. Click Setup Medicare Online Claiming
  3. Follow the guided setup wizard:
    • Enter your PRODA Organisation ID (RA number)
    • Register a B2B device in Praxi (device name) — Praxi generates the RSA key pair and Device Activation Code
    • Activate that code in the PRODA portal under B2B Devices (production code valid one day per SA education)
  4. Click Test Connection
  5. Review test results (should show "Connected" status)
  6. Save when successful

For detailed instructions, see the PRODA B2B Device Setup guide. SA education: Managing B2B Devices.

Medicare claiming configuration with PRODA setup

Getting Your Medicare Credentials​

If you don't have Medicare claiming credentials:

  1. Register for PRODA: Visit Provider Digital Access / PRODA login
  2. Link your organisation: In PRODA, link to your practice organisation
  3. Lodge HW027: Submit the Third Party Access Authority form to authorise Praxi as your claiming software
  4. Register B2B device in Praxi, then activate in PRODA with the DAC Praxi shows (one-day production validity — complete promptly)

Provider Registration​

Each claiming practitioner needs:

  1. Open Users from the Practice menu
  2. Select the practitioner
  3. Under Medicare, enter:
    • Provider number
    • Specialty code
    • Location ID (if different from practice default)

Claiming Options​

OptionDescription
Bulk BillMedicare pays directly, no client charge
GapClient pays difference between your fee and rebate
PrivateNo Medicare claim, full client payment

Configure default per practitioner or override per invoice.

Medicare Item Numbers​

Praxi includes a built-in database of MBS item numbers. The MBS-item picker on each invoice filters items by the practitioner's endorsement automatically. Set your standard fee for each item at Settings → Billing → Medicare.

Praxi's claiming screens suggest the correct Better Access item for the provider type and session duration -- see the MBS Item Picker for how items are selected. Always confirm item selection against the current MBS.

DVA (Veterans' Affairs)​

Prerequisites​

  • Medicare provider number -- DVA claims use your standard Medicare provider number (the same one used for Medicare claiming)
  • PRODA device configured -- DVA claims are submitted via the same MCOL connection as Medicare
  • DVA fee schedule -- Current DVA fee rates (updated periodically)

Setting Up DVA​

DVA claiming uses the same MCOL connection as Medicare, so it follows the same certification timeline. Once your PRODA device is configured (see PRODA Setup), no separate DVA setup is needed. Confirm your practice location details are correct at Settings > Billing > Medicare.

DVA billing configuration with card type and fee schedule settings

DVA Card Types​

Configure handling for each card type:

CardColourCoverageClaiming Requirements
GoldGoldAll conditionsDirect claim, no referral needed
WhiteWhiteSpecific conditions onlyVerify condition is covered, referral may be required
OrangeOrangePharmaceutical onlyNot applicable for psychology

DVA Fee Schedule​

DVA pays at scheduled rates -- you cannot charge above the DVA fee schedule. Praxi keeps the current DVA items and rates up to date in the claiming screens, so always use the fee shown there rather than a printed schedule.

warning

No gap billing: DVA clients cannot be charged a gap. You must accept the DVA fee as payment in full for covered services.

DVA Claiming Process​

  1. Verify client's DVA card and eligibility
  2. Provide service and complete clinical note
  3. Create invoice with DVA item numbers (DVA maintains a separate fee schedule from MBS)
  4. Submit claim via MCOL (primary) or Tyro Health (optional alternative)
  5. Track payment (typically 10-14 business days)

NDIS​

Prerequisites​

  • NDIS registered provider (recommended)
  • Understanding of NDIS pricing arrangements
  • Knowledge of support categories

Setting Up NDIS​

  1. Go to Settings → Billing → Funding Sources
  2. Click NDIS
  3. Enter:
    • Provider Registration Number (if registered)
    • ABN
    • Default Support Category (usually 15 - Improved Daily Living)
  4. Save

NDIS Price Guide​

Praxi updates the NDIS price guide automatically when the NDIS releases new rates. Configure your rates at Settings → Billing → NDIS and set your fee for each support item — rates must comply with NDIS Price Guide limits.

Common psychology NDIS rates (2024-25 Price Guide):

Support ItemItem NumberPrice LimitTravel
Assessment (Standard)15_056_0128_1_3$214.41/hrClaimable
Individual Therapy15_040_0128_1_3$214.41/hrClaimable
Group Therapy (1:2)15_041_0128_1_3$107.21/hr-
Group Therapy (1:3)15_042_0128_1_3$71.47/hr-
Report Writing15_047_0128_1_3$214.41/hr-
info

Price limits: the NDIS publishes maximum prices annually (usually July). Your rates cannot exceed these limits but can be lower. Praxi updates the price guide automatically when NDIS releases new rates.

NDIS Cancellation Policy​

NDIS allows you to charge for late cancellations:

Notice PeriodClaimable Amount
Less than 7 days (no show)100% of service price
Less than 7 days (short notice)90% of service price
7+ clear business daysNo charge permitted

Configure your cancellation policy at Settings → Billing → NDIS.

Plan Management Types​

Configure invoicing for each type:

TypeYour ActionPayment TermsTypical Payment Time
Self-managedInvoice participant directlyAs negotiated7-30 days
Plan-managedInvoice plan managerManager's terms14-45 days
NDIA-managedSubmit through NDIS portal14 days14-21 days

Plan Manager Directory​

Praxi maintains a directory of common NDIS plan managers:

Plan ManagerInvoicing MethodTypical Payment
Plan PartnersEmail or portal14 days
Maple Plan ManagementEmail21 days
My Plan ManagerPortal upload7-14 days
NDSPEmail14 days
ClickabilityPortal14 days

Plan managers are added when you create a new NDIS client funding source — the plan manager's details are saved and reused across clients automatically.

NDIA-Managed Claims​

For NDIA-managed participants, submit claims via the NDIA portal:

  1. Go to Billing → NDIS Claims
  2. Select NDIA-managed invoices
  3. Click Generate Claim File
  4. Download the NDIS claim file (CSV format)
  5. Log into the NDIS myplace provider portal
  6. Upload the claim file
  7. Monitor claim status in portal
  8. Mark as paid in Praxi when payment received

Service Bookings​

For NDIS clients with service bookings:

  1. Client provides booking reference (format: SB-XXXXXXXX)
  2. Enter in client's Funding Sources section
  3. Claims automatically reference the booking
  4. System tracks budget usage against booking
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Service agreements: best practice is to have a signed service agreement with each NDIS client before commencing services. Praxi includes a service agreement template you can send for signature from the client's Documents tab.

Private Health Insurance​

Direct Claiming (Tyro HealthPoint or HICAPS)​

If you have a Tyro HealthPoint or HICAPS terminal:

  1. Go to Settings → Billing → Funding Sources
  2. Click Private Health
  3. Enter terminal details (Tyro or HICAPS)
  4. Test connection
  5. View supported health funds at Billing > Private Health > Supported Funds

Invoice-Based​

For clients to claim themselves:

  1. Configure your invoices to include:
    • Provider number
    • Service description
    • Item codes
  2. Client submits to their fund

WorkCover​

State-Based Configuration​

WorkCover operates differently by state:

StateSchemeConfiguration
VICWorkSafe VictoriaEmployer insurer details
NSWSIRAicare portal access
QLDWorkCover QueenslandDirect registration
WAWorkCover WAInsurer registration
SAReturnToWorkSAPortal access

Setting Up WorkCover​

  1. Go to Settings → Billing → Funding Sources
  2. Click WorkCover
  3. Select your state(s)
  4. Enter registration details
  5. Configure approval workflows

Pre-Approval Tracking​

WorkCover typically requires pre-approval:

  1. Session limit per claim
  2. Report requirements
  3. Progress reviews

Configure alerts at:

Settings → Billing → WorkCover → Alerts

EAP (Employee Assistance Programs)​

Adding EAP Providers​

  1. Go to Settings → Billing → Funding Sources
  2. Click EAP
  3. Click Add Provider
  4. Enter:
    • Provider name (e.g., Converge, AccessEAP)
    • Billing contact
    • Session limits
    • Fee schedule
  5. Save

EAP Billing Process​

  1. Client books using EAP reference
  2. Session completed and noted
  3. Invoice generated to EAP provider
  4. Submitted per EAP requirements

TAC (Transport Accident Commission)​

Victoria-specific for motor vehicle accidents:

Setting Up TAC​

  1. Go to Settings → Billing → Funding Sources
  2. Click TAC
  3. Enter provider registration
  4. Configure fee schedule

TAC Requirements​

  • Pre-approval for treatment
  • Progress reports at intervals
  • Claim number on all invoices

Healthcare Validation Cache​

Praxi maintains an intelligent validation cache for healthcare credentials to reduce external API calls and speed up billing workflows. Credentials are validated against the relevant authority and cached with type-specific time-to-live (TTL) values:

Credential TypeCache TTLValidation Source
AHPRA12 monthsAHPRA Public Register
Medicare6 monthsMedicare Web Services
DVA6 monthsDVA Provider Portal
NDIS3 monthsNDIS Provider Register

How Validation Works​

  1. Format validation - Credential format checked locally (e.g., Medicare number structure)
  2. Cache lookup - System checks if a valid cached result exists within TTL
  3. Verification status - Cached credentials return verified status; uncached or expired credentials return pending_verification or format_valid until verified by an administrator
  4. Cache refresh - Expired entries are re-validated on next use
info

Known MBS items: Praxi includes a built-in database of known MBS item numbers (e.g., 80000–80150 for psychology and allied health). Known items are validated immediately. Unknown item numbers are flagged for manual verification.

Testing Funding Sources​

Medicare Test Claims​

Use Medicare's test environment:

  1. Settings → Billing → Medicare
  2. Click Test Mode
  3. Submit test claim
  4. Verify response

Validation Checklist​

Before going live:

  • Credentials entered correctly
  • Test connection successful
  • Provider numbers verified
  • Fee schedules configured
  • Invoice templates include required details
  • Healthcare validation cache populated for active clients

Troubleshooting​

Medicare Connection Failed​

Common causes:

  • RSA key expired (check key rotation status in Settings > Billing > Medicare)
  • PRODA device locked (too many authentication failures)
  • PRODA organisation not linked
  • Location ID mismatch

DVA Claims Rejected​

Check:

  • Card type matches service
  • Condition approved (White card)
  • Provider number valid
  • Fee within schedule

NDIS Payment Delayed​

Verify:

  • Plan dates current
  • Budget available
  • Correct plan manager
  • Service booking valid

Tips​

  1. Test before production - Use test environments first
  2. Monitor key health - Check PRODA device key status regularly
  3. Update fee schedules - Review when NDIS/Medicare rates change
  4. Train staff - Ensure team understands each funding type
  5. Document exceptions - Note any special arrangements

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