Case Study
How a new SIL provider found $3,100+ in recoverable billing errors — in 28 days
A three-way reconciliation across ShiftCare, Xero, and the plan manager ledger. 107 line items. One missing process. Seven business days to fix.
The Headline
A new SIL provider was overspending by $3,100+ a month and didn't know it. Their billing was correct on every line. The problem was a missing process. Splana found it in 5 business days and built the fix in 7.
At a Glance
| Engagement type | Integration Service ($4,497) |
|---|---|
| Provider | New SIL provider, single participant (anonymised) |
| Systems reviewed | ShiftCare (rostering) + Xero (accounting) + plan manager ledger |
| Analysis period | 28 days, 107 individual line items |
| Diagnostic time | 5 business days |
| End-to-end resolution | 7 business days |
| Issue identified | $3,123 overspend in the first SIL funding period |
| Recoverable claims | $3,171 in error claims pathway established |
The Situation
A newly registered NDIS provider began SIL services for their first participant in late 2025 — 24-hour support, 1:1 daytime and evening assistance, an inactive overnight sleepover, and daily community access. A few months in, the participant's plan transitioned from 1:1 to a 1:3 shared living model. The NDIA front-loaded the first funding period with a higher allocation — $31,627 instead of the standard $19,396 — to cover continued 1:1 delivery while housemates were recruited.
One month in, a routine check found the provider had billed over $34,750 in SIL claims — more than $3,100 past even the enhanced buffer. Several end-of-period claims came back as errors. Services had been delivered that could not be paid for.
What We Found
The billing was correct. The process was missing.
Finding 1
Every line was right.
Every line item code, every rate, every budget category routing was accurate. SIL claims used the 01_8xx series at 1:1 rates consistent with the 2025–26 Price Guide. Community access was correctly separated into Core: Community Participation under 04_1xx. This was not a billing error.
Finding 2
The buffer was structurally short.
At 1:1 delivery, a standard weekday cost approximately $1,043 (daytime $281 + evening $464 + sleepover $298). With weekend loadings and a public holiday, the 28-day period required roughly $34,750 in SIL funding. The $31,627 transitional buffer was about 10% short of actual delivery cost.
Finding 3
Budget exhaustion was invisible until it bit.
The provider had no process to compare cumulative claims against the funding period allocation as the month progressed. The first signal of a problem was when the plan manager returned the final four days of claims as errors. By then, the services had already been delivered and paid for in wages.
What We Delivered
Four actions, end-to-end, in 7 business days
- 1.
Error claims recovery pathway.
Worked with the plan manager to determine the right mechanism for resubmitting $3,171 in error claims against the next funding period, using the plan's rollover provisions.
- 2.
1:3 transition verification.
Confirmed ShiftCare billing configuration had been updated to reflect the 1:3 shared living ratio from the transition date. Verified that daily SIL cost dropped from ~$1,043 to ~$570, aligning with the ongoing monthly allocation.
- 3.
Monthly reconciliation protocol.
Delivered a pre-submission checklist requiring cumulative SIL claims to be compared against the funding period allocation before invoicing. Submission pauses for review if claims exceed 80% of the period allocation with more than a week remaining.
- 4.
Active overnight documentation standard.
Established a log for recording every instance of active support beyond the sleepover inclusion, with timestamps and reasons, to protect the provider in future audits.
The Outcomes
| Overspend identified | $3,123.24 |
|---|---|
| Error claims recoverable | $3,171.14 |
| Billing errors found | Zero — every rate and code was correct |
| Ongoing daily risk | Eliminated — 1:3 configuration verified, daily cost reduced ~45% |
| Prevention system | Monthly reconciliation protocol implemented |
| Time to full resolution | 7 business days from engagement |
Why This Matters
Most billing leakage isn't a billing error
This provider was doing almost everything right. Codes, rates, routing — all correct. They were billing for services they had legitimately delivered. The single missing element was a reconciliation process: a systematic check between what was being billed and what the plan budget could sustain. Without it, a structural shortfall was invisible until it triggered rejected claims.
For new SIL providers, this is a common risk pattern. For mid-market providers running multiple participants across multiple plans, the same gap exists at scale — and the dollar exposure is materially larger. The Integration Service is built around finding it before it triggers an audit, a margin shortfall, or a year-end surprise.
Third-Party Context
RSM Australia research suggests a typical 100-participant NDIS provider loses approximately $285,000 per year through billing errors, unbilled shifts, late clockouts, and rejected claims. The case above represents one structural shortfall on one participant. Across a portfolio, the cumulative leakage adds up fast.
Source: RSM Australia.
Ready to see what your billing is hiding?
Splana's Integration Service maps the connection between your rostering and accounting systems, identifies where revenue is leaking, and delivers a working reconciliation protocol. $4,497, 4–6 weeks. Or start with the free 10-minute Billing Leakage Self-Diagnostic to score your own risk first.