Skip to main content

Funding Sources

Praxi supports multiple funding sources common in Australian healthcare. Configure client funding to streamline billing and claiming.

Supported Funding Sources​

SourceDescriptionClaiming Method
MedicareMedicare Mental Health PlanOnline claiming (MCOL)
DVADepartment of Veterans' AffairsOnline claiming
NDISNational Disability Insurance SchemeNDIS portal/invoicing
Private InsurancePrivate health insuranceInvoice for client
WorkCoverWork injury compensationInsurer direct billing
TACTransport Accident Commission (VIC)TAC portal
Private PaymentSelf-funded / private payDirect invoicing
EAPEmployee Assistance ProgramsEmployer billing
Legal AidLegal Aid funded sessionsLegal Aid billing
Court FundedCourt-ordered assessments/treatmentCourt billing
Government FundedOther government-funded programmesAgency billing
Pro BonoNo-charge sessionsNot billed
OtherAny other funding arrangementVaries

Medicare​

Mental Health Treatment Plan​

Clients need a GP referral and Mental Health Treatment Plan to access Medicare rebates.

Requirements​

  • Current Mental Health Treatment Plan (valid 12 months)
  • GP referral to your practice
  • Valid Medicare number
  • Client consent for Medicare claiming

Setting Up Medicare​

Medicare details are recorded on the client's Billing tab. Enter:

  • Medicare number (exactly 10 digits, checksum validated)
  • IRN (Individual Reference Number, 1-9)
  • Expiry date
  • GP referral date
  • Number of sessions allocated

Session Tracking​

Medicare provides up to 10 sessions per calendar year:

  • Sessions 1-6: Initial allocation
  • Sessions 7-10: After GP review

Praxi tracks:

  • Sessions used
  • Sessions remaining
  • Expiry warning
  • GP review reminder

Medicare Item Numbers​

Praxi includes the full MBS schedule with current item numbers, fees, and benefit amounts, and the claiming screens suggest the right item for the session's provider type and duration. See the MBS Item Picker for how items are selected and the Medicare billing section for claiming workflows.

Bulk Billing vs Gap Payments​

Bulk billing: Medicare pays directly, no client charge Gap payment: Client pays the difference between your fee and Medicare rebate

Configure billing type:

  1. Go to the client's Billing tab and open the Medicare section
  2. Set Billing Method:
    • Bulk bill
    • Gap (specify client contribution)
    • Private (no Medicare claim)

DVA (Veterans' Affairs)​

DVA Card Types​

CardColourCoverage
GoldGoldAll conditions
WhiteWhiteAccepted conditions only
OrangeOrangePharmaceutical only

Setting Up DVA​

DVA details are recorded on the client's Billing tab. Enter:

  • DVA file number
  • Card type and colour
  • Accepted conditions (if White card)
  • GP referral details

DVA Claiming​

DVA claims are submitted similarly to Medicare:

  • Verify treatment is for accepted condition
  • Use DVA-specific item numbers
  • Claims processed through Veterans' Affairs portal

NDIS​

NDIS Plan Management​

NDIS participants have different plan management types:

TypeInvoicing
Self-managedInvoice participant directly
Plan-managedInvoice plan manager
NDIA-managedSubmit through NDIS portal

Setting Up NDIS​

NDIS details are recorded on the client's Billing tab. Enter:

  • NDIS number
  • Plan start and end dates
  • Management type
  • Plan manager details (if applicable)
  • Budget allocation (if known)

NDIS Support Categories​

Relevant categories for psychology:

CategoryCodeTypical Use
Improved Daily Living15Capacity building
CB Psychological Recovery15Mental health support

NDIS Invoicing​

For plan-managed participants:

  1. Create invoice in Praxi
  2. Include:
    • NDIS number
    • Support category
    • Line of item support
    • Date of service
  3. Send to plan manager

For self-managed:

  • Invoice directly to participant
  • They claim from their plan

Private Health Insurance​

Setting Up Private Health​

Private health insurance details are recorded on the client's Billing tab. Enter:

  • Health fund name
  • Member number
  • Extras cover level
  • Policy holder (if different)

Claiming Process​

Most private health claims are client-initiated:

  1. You invoice the client
  2. Client pays your invoice
  3. Client claims rebate from their fund
  4. Fund reimburses client

Some funds allow direct billing - check with the fund.

WorkCover​

State-Based Schemes​

WorkCover varies by state:

StateScheme
VICWorkSafe Victoria
NSWState Insurance Regulatory Authority
QLDWorkCover Queensland
WAWorkCover WA
SAReturnToWork SA

Setting Up WorkCover​

WorkCover details are recorded on the client's Billing tab. Enter:

  • Claim number
  • State/scheme
  • Case manager details
  • Authorised sessions
  • Date of injury

WorkCover Billing​

  • Usually requires pre-approval for sessions
  • Bill the insurer directly
  • Include claim number on all invoices
  • Track authorised vs. used sessions

Multiple Funding Sources​

Clients can have multiple funding sources:

Priority Order​

When a client has multiple active sources, Praxi selects the default payer for each appointment in a fixed order: WorkCover, then DVA, then NDIS, then EAP, then Medicare (Mental Health Care Plan), then private health fund -- falling back to private billing when none applies. You can always change the payer on an individual invoice before it is issued.

Funding Alerts​

Praxi alerts you to funding issues:

Automatic Alerts​

  • Sessions running low - 2 sessions remaining
  • Referral expiring - 30 days before expiry
  • Plan ending - NDIS plan end date approaching
  • Approval needed - WorkCover sessions exhausted

Dashboard Notifications​

Check your dashboard for:

  • Clients needing GP review
  • Expired referrals
  • NDIS plans ending
  • Outstanding approvals needed

Healthcare Number Validation​

Praxi validates healthcare identifier numbers when they are entered on a client profile. The validation system checks AHPRA, Medicare, DVA, and NDIS numbers for correct formatting.

How Validation Works​

When you enter a healthcare number, Praxi performs a format check and returns one of the following statuses:

StatusMeaning
format_validThe number matches the expected format
pending_verificationThe format is correct but external verification has not yet completed
verifiedThe number has been verified against the external registry
unknown_itemThe item number is not recognised (for MBS lookups)

Validation results are cached to reduce repeated lookups:

IdentifierCache Duration
AHPRA12 months
Medicare6 months
DVA6 months
NDIS6 months

For MBS item numbers, known Better Access items return verified. Unknown item numbers return unknown_item rather than a false positive.

Validation Does Not Replace External Checks

The validation system confirms that a number is correctly formatted and caches verified results. It does not guarantee real-time eligibility. Always confirm eligibility with the relevant authority when in doubt.

Tips​

  1. Verify funding at booking - Check sessions/approvals before scheduling
  2. Track referral dates - Set reminders for GP reviews
  3. Update NDIS plans - Get new plan details promptly
  4. Keep details current - Medicare numbers can change
  5. Document approvals - Keep records of pre-approvals

Troubleshooting​

Medicare Claim Rejected​

Common reasons:

  • Invalid Medicare number
  • Sessions exceeded
  • Referral expired
  • Item number not matching service

NDIS Budget Exhausted​

Options:

  • Contact plan manager
  • Wait for plan review
  • Convert to self-funded
  • Discuss reduced session frequency

Was this page helpful?