PRODA Payment Request API User Guide

Please note you will need to have a HICAPS registration that is synced with Careview before using this process. Please refer to the attached guide for instructions on signing up for HICAPS If you have any questions please contact support@careviewapp.com

For this feature the Use Payment Summary File setting will have to be enabled. If you are unfamiliar with this please refer to our NDIS Payment Reconciliation User Guide for more information. 

1. Enable the PRODA Payment Request API under NDIS Sync Pro - PACE & PRODA API settings 

Navigate the PRODA Payment Request Screen

Screen Filters

The screen can be filtered using any of the following:

1. Client Name
   
2. Invoice Number
   
3. Payment Request Number (search by the PRN provided in the PRODA Payment Summary File)
4. Claim Status
   
5. Paid Date
   
6. Claims Created From and To Dates
   
7. Exclude Processed Claims (Excludes $PAID and Payment Pending claims only)

The selected filters will NOT persist if user refresh or navigate to other pages.

Use the Clear Filter button to clear any preset Filters selected.

View Claim and Benefit Totals

View the Total Claim Amt or Total Benefit Amt by selecting any available filters, and click on the text link to display the Amount.

Sort functions

You can sort data across various columns to streamline your work and find claims submitted to PRODA more efficiently.

Locate the column you want to sort the list by, and click on the column name. This will activate the sort function, and a small arrow icon will appear next to the column header, indicating the sort direction.

By default, the PRODA Payment Request table is sorted ascending by Submitted Date.  However, users have the ability to sort data in ascending or descending order, or from newest to oldest.

Claim Selection

You can select claim/s by doing either of the following.

1. Click on any claim row to select a claim.
   

          OR

1. Click on the first claim row and hold down the Shift key and click on the last row to make your selection.
   

Page View

You can choose to display 100, 200, or up to 500 records on the screen. 

Total items number displays below the list on the left side.

How to Submit a Claim to PRODA

1. From the Service Entry screen, select an Extract Generated invoice to claim.

2. Under the Action menu, click to select Submit Claim to PRODA.

3. The Payment Request Summary screen displays. 

On hold invoices will be omitted from the submission if they are selected.

4. Click on Confirm.

5. The Payment Request Submitted dialog screen displays.  To check how the claim is processing, click on the hyperlink and the PRODA Payment Request screen will load in a new browser tab.

5.  The PRODA Payment Request screen displays in a new browser tab. 

Please note there will be a claim record per invoice line. E.g If you claim an invoice with 3 lines, there will be three claim records submitted to PRODA. Each one will be referenced within the  PRODA Payment Request screen.

On the Payment Requests screen, clicking on the Invoice number will take you to the relevant invoice entry.  Similarly on the invoice entry screen, click on the invoice number will open the associated payment request claims. 

Claim Statuses 

Cancelled - claim has been cancelled 

Error - system error

Open - claim submitted, awaiting adjudication 

Paid - claim has been approved and paid

Payment Pending - claim has been approved, awaiting payment

Processed - submission is being processed

Rejected - claim has been rejected, failure reason is populated by NDIS rejection code, OR no response has been received, and the claim has timed out. If the latter occurs, we recommend resubmitting the claim. 

6. Once the claims status updates to Approved, the invoice status will automatically update to either Fully Reconciled - Ready for provider payment if the payment matches the claim amount (or falls within the tolerance set in your reconciliation settings) or Part Paid - Requires reconciliation if there are some lines on the invoice paid and some that are still pending payment (or falls outside the tolerance set in your reconciliation settings) on the Service Entry screen.

How to Re-submit a Claim

If you received an API Timed Out Error or the Claim was Rejected due to an issue within PRODA please correct the issue within PRODA before clicking on Submit Claims. 

If the error is within the invoice in Careview,  edit the line item within the invoice before re-submitting via the process below.  Each claim will contain the correlating DS reference of the invoice line for easy identification.

Please note if you have made changes to the invoice line item within Careview the updated amounts won't appear until the new claim record has started processing. 

1. From the PRODA Payment Request screen, click to select the claims with a status of Error or Rejected and follow the steps covered under How to Submit a Claim to PRODA.

How to Cancel a Claim

If you need to cancel a claim. You can cancel it from the PRODA Payment Request or via the Service Entry screen. 

1. If you are wanting to cancel specific claims, cancel the claim/s via the PRODA Payment Request feature.
   
2. If you are wanting to cancel all claims that relate to a specific Invoice, cancel the claim via the Service Entry feature.
   

Cancel a Claim via the PRODA Payment Request Feature

Note you will only be able to cancel a claim with the status of PAID, PAYMENT PENDING, REJECTED or ERROR.

If you need to cancel all claims in an Invoice, please ensure you filter on the invoice number in the top left and select all line items

1. From the PRODA Payment Request screen, select the claim/s you wish to cancel and under the Action menu, select Cancel Claims.

2.  Cancel Claims Confirmation screen displays, click on Confirm to proceed.

3.  Confirmation that the cancellation request has been submitted to PRODA dialog displays.

4.  Invoice Status is set to Extracted with On Hold Reason until Careview receives a response from PRODA.

5.  If the cancellation request has been actioned by PRODA successfully the record will be updated with the Claim status of Cancelled.

6.  The Claim Status is updated based on the following responses received from PRODA.

Cancelled - Claim is cancelled in PRODA

Error - System error has occurred, request was not submitted.

Other State - Cancel claim request is rejected, claim status is reverted to previous state.

7.   The Invoice Status will update based on the Claim Status received from PRODA.

Claim Cancelled - If all claims are cancelled and the Claim Status = Cancelled on all Claims within an Invoice.

Claim Partially Cancelled - If not all claims are cancelled within an Invoice.

Extracted On Hold - If a system error occurred or no response is received for claim requests submitted for cancellation.

Previous Invoice State i.e. Invoice Status prior to claim cancellation is Part Paid - Requires Reconciliation, claim submitted for cancellation and Invoice Status is set to Extracted with On Hold Reason.  If all cancel claim requests are rejected the Invoice Status of Extracted with On Hold Reason, will return to the previous status of Part Paid - Requires Reconciliation.

Cancel a Claim via the Service Entry Feature

1. From the Service Entry screen, select the Invoice where you wish to cancel all claims submitted to PRODA, and under the Action menu, select Cancel PRODA Claims.

2.  Cancel PRODA Claims Summary screen displays.

3.  Click on Confirm.

4.  Confirmation that the cancellation request has been submitted to PRODA dialog displays.

5. Click on OK.

6.  Invoice Status is set to Extracted with On Hold Reason until Careview receives a response from PRODA.

7.  The Invoice Status will update based on the Claim Status received from PRODA.

Claim Cancelled - If all claims are cancelled and the Claim Status = Cancelled on all Claims within an Invoice.

Claim Partially Cancelled - If not all claims are cancelled within an Invoice.

Extracted On Hold - If a system error occurred or no response is received for claim requests submitted for cancellation.

Previous Invoice State i.e. Invoice Status prior to claim cancellation is Part Paid - Requires Reconciliation, claim submitted for cancellation and Invoice Status is set to Extracted with On Hold Reason.  If all cancel claim requests are rejected the Invoice Status of Extracted with On Hold Reason, will return to the previous status of Part Paid - Requires Reconciliation.

How to Split a Claim to a New Invoice

Follow these steps to split line items to a new invoice, for example an Invoice consists of 4 Claims and one has been rejected, instead of Cancellation this Claim, you can split the successful claims to a new invoice.

1.  From the PRODA Payment Request screen, select the claim/s you wish to split to a new invoice and under the Action menu, click to select Split Claims to New Invoice.

2.  Click on Confirm to proceed.

3.  Confirmation dialog displays, confirming a new invoice has been created.

4.  Click on Close.

5.  A new Invoice is created with the selected Claim/s, the Invoice Number assigned will be [Original Invoice Number]-split and the Original Invoice details will be updated to reflect the split items.

View a Selection of Invoices on the Service Entry Screen

1.  From the PRODA Payment Request screen, click to select the Claim/s, and under the Action Menu, clicks on View Invoices.

2.  The Service Entry screen displays in a new browser tab, and only the invoices related to the claims selected are displayed on the screen, regardless of whether only a single claim is selected.

3.  The Invoices will remain persistent on the Service Entry screen, so you can freely Edit an Invoice and return to view only those Invoices selected from the PRODA Payment Request screen.  

To return to the default Service Entry landing page, either navigate away from the Service Entry screen, close the browser tab or click on the Clear Filters button.

• Related Articles

• NDIS Payment Reconciliation User Guide

  Overview This feature will enable you to simply upload the Proda Payment Summary file (refer to How to Retrieve the Proda Payment Summary File) in its current format, straight into Careview, via the Reconcile Payment system function. This function ...

• PRODA Payment Request API - Unit Price Claimed is above NDIS Price Limit Claim Rejection Resolved

  The following system validation has been implemented to resolve the numerous PRODA “unit price claimed is above the NDIS price limit” claim rejections received when submitting claims via the Payment Request API. This issue does not apply to Manual ...

• PRODA API - Service Bookings Troubleshooting guide

  Troubleshooting for Service Bookings PRODA API Not synchronized with PRODA error When you first sync an active plan with PRODA. You may receive a "Not Synchronized with PRODA error" within the client's Service Contract. Common reasons for this ...

• Quickbooks Settings User Guide

  About  Careview has the capability to extract Quickbooks extracts in CSV file format that can then be uploaded into Quickbooks. These Quickbooks extracts are created from the:  1. Invoice Entry Screen (Plan Management).  2. Support Coordination CoS ...

• MYOB Settings User Guide

  About  Careview has the capability to extract MYOB extracts in CSV file format that can then be uploaded into MYOB. These MYOB extracts are created from the:  1. Invoice Entry Screen (Plan Management).  2. Support Coordination CoS NDIS Claim ...