IMPORTANT NOTE: If you submit claims directly to PRODA without generating them in Eziplan, you won't be able to:
Upload reconciliation files
Generate statements
Always generate your claim records in Eziplan first, then submit the file to PRODA.
Claiming Overview
Stage 1 – Creating a Claim
This stage allows users to begin creating a new claim. The system will collate all appointments and supplier invoice item lines that meet the following criteria:
Within the claim date range
Attached to a valid SAH Funding Type
Not previously claimed
Stage 2 – Review Claim
Users must review the claim and resolve any errors identified by Eziplan. These may include:
No SAH Service Type Association found
No active budget found
No matching budget lines found
Units in appointment/invoice are 0
Rate is 0
Missing SAH wrap/item
Stage 3 – Finalise and Export
Once all errors have been resolved, providers can download an export file formatted for direct upload to PRODA.
After the claim has been finalised in PRODA, providers can import a Payment Summary File into Eziplan's Reconciliation module. This will be covered in a separate article.
Changes Compared to Home Care Packages
It is important to understand that there are key differences in how claims are managed under Support at Home compared with Home Care Packages.
Claiming Period
Under Home Care Packages, claiming occurred month-by-month for services delivered in that month. Under Support at Home, the claiming period is quarter-by-quarter plus 60 days. This can create scenarios such as:
You may have claims for services delivered in November and December at the same time.
You may be in January raising claims for services delivered in November.
You may claim for January services one week, then the following week claim for November services.
Claiming Based on Date of Service
Under Support at Home, providers claim based on the Date of Service. This aligns with quarterly budget periods and means you may claim in January for services delivered months earlier. Claiming by Date of Service ensures the correct carry-over of funds.
Level of Information Sent
Under Home Care Packages, only basic information—client and total claim value—was sent to the Government.
Under SAH, every individual service line is submitted to the Government for payment. This significantly increases data requirements and is why the system has been redesigned to support this level of detail.
Disconnect Between Claims and Statements
Because claiming is based on quarterly periods, there is now a significant disconnect between statements and claims. Under Home Care Packages, these were linked 1:1.
Under Support at Home, you may be claiming for services delivered in previous months. Eziplan's new Statements module will manage this by allowing previous months’ services to appear as amendments on the current month’s statement. This approach is recommended by the Department of Health.
Accounting Best Practices
The difference between Date of Service and Date of Claim may cause confusion in accounting systems. Eziplan has consulted with providers and suggests the following best practice:
Create General Ledger Journals for each claim upon reconciliation. During the reconciliation process, providers will receive a breakdown of:
How much was claimed
How much will be paid:
How much the Government will pay
How much the client will need to co-contribute
This provides sufficient information to map the transaction correctly in a journal.