Claim rules · Article 1 of 4
Understanding claim rules
Claim rules are how your team encodes funding decisions as automatic checks on invoices. They catch problems — items not in plan, unauthorised suppliers, costs needing review — before an invoice is processed, so your team isn't reviewing the same edge cases by hand on every claim.
What claim rules do
Plan management is regulated work. Every invoice you process eventually becomes an NDIS claim, and claims that fall outside what a customer's plan actually funds — wrong items, wrong supplier, wrong period — create compliance problems and rework when they're rejected by the NDIS.
Reviewing every invoice line item by hand is slow and error-prone. Claim rules are your team's way to bake those checks into Navigator so they happen automatically. A rule says: "For this customer (or this supplier, or this combination), if you see these support items, do X." Where X is one of three things:
- Block — stop the invoice. Don't let it move forward until someone resolves it.
- Warn — flag it so a human looks before approving.
- Authorise — confirm it's fine, even if other signals would normally raise a flag.
Set the rule once and Navigator applies it to every matching invoice that arrives.
Where claim rules fit in the invoice flow
Rules are evaluated as part of invoice processing — between the invoice arriving and it being approved. They're a gate, not a report.
Claim rules run automatically at Step 2, immediately after an invoice arrives. A Blocked rule halts the invoice at this point. A Warning rule lets it continue but raises a flag for the reviewer. An Authorized rule explicitly clears it. Either way, the rule has already done its job before a person picks up the invoice.
The three rule types
Every rule has one of three types. The choice determines how aggressively Navigator intervenes.
Navigator halts processing. The invoice can't move forward until the rule is resolved or removed.
Navigator surfaces a warning to the reviewing team. The invoice continues, but the reviewer must consciously acknowledge it.
Navigator confirms the invoice is permitted — overriding flags or blocks that would otherwise trigger for the same items.
The three rule types. Most rules teams set up are Blocked or Warning — guards against specific issues. Authorized is rarer and used to explicitly clear items that would otherwise be caught by other checks.
What a rule can target
Every rule is scoped along two axes — who the rule applies to and which items it covers. You must always set at least one part of the "who", but the "which items" can be left open.
| Scope | What it means |
|---|---|
| Customer | Applies to all invoices for this customer, regardless of supplier. |
| Supplier | Applies to all invoices from this supplier, regardless of customer. |
| Customer and supplier | Applies only when that specific combination appears together on an invoice. |
| Support items | Optional. Restrict the rule to specific NDIS support items, an entire category, or a claim rule group. If left blank, the rule covers all items on matching invoices. |
| Date range | Required. The rule is only active between its start and end dates. Often tied to a customer's support plan dates so the rule expires automatically when the plan does. |
Claim rule groups
Some scenarios come up over and over — for example, the NDIS-authorised list of continence supplies, or the standard set of Core supports that should be blocked by default. Rather than recreating the same item lists each time, teams can apply a claim rule group: a pre-built bundle of NDIS support items maintained by Kismet.
Selecting a group has two effects:
- Every item in the group is added to your rule at once.
- The group's name becomes the rule's reason automatically (e.g. "Consumables – Continence Supports (NDIS Authorised)") — you don't need to type one yourself.
Groups are curated by Kismet and update when the NDIS support catalogue changes. You can't create or edit groups yourself. Common examples on the platform today:
- Standard CORE – Blocked — Core supports that should be blocked by default.
- Standard CORE – Authorized — Core supports that are explicitly cleared.
- Consumables – Continence Supports (NDIS Authorised) — items requiring explicit NDIS authorisation.
- Intensive & Complex Behaviour Supports (NDIS Authorised) — high-cost behaviour support items.
- Related to Disability – Nursing — nursing items requiring verified disability.
If you think a group needs an item added or removed, contact your Kismet team.
Where to find claim rules
Claim rules don't have a top-level navigation item in Navigator. They're reached from a customer's or supplier's profile:
- From a customer profile — open the More… menu and select View claim rules. The claim rules screen opens pre-filtered to that customer.
- From a supplier profile — select View claim rules from the sidebar action area. The claim rules screen opens pre-filtered to that supplier.
This is by design: claim rules exist for a customer or supplier, so you nearly always want to view or change them in that context. To see every rule on your account at once, clear the filter at the top of the claim rules screen.
How rules are evaluated
When an invoice is processed, Navigator runs the following check automatically:
- Find candidate rules Navigator pulls every claim rule for your account that is active on the invoice date (i.e. the invoice date sits between the rule's start and end dates).
- Match scope For each candidate, it checks whether the rule's customer, supplier and support items all match the invoice. A rule with no specific items matches any item; a rule scoped to a customer-only matches any supplier; and so on.
- Apply the strongest outcome If a matching Authorized rule exists, the invoice is cleared for that item. Otherwise a matching Blocked rule halts the invoice, or a matching Warning rule raises a flag for the reviewer.
- Surface the result on the invoice Blocked invoices display a message including the rule's reason — for example: "Invoice cannot be processed. There is a claim rule blocking line item 01_011_0107_1_1 for the following reason: {reason}". Warnings appear as flags the reviewer must acknowledge.