Special Education Medicaid Reimbursement Filing Services

The Vendor is required to provide special education Medicaid reimbursement filing services for include:
- Claims preparation
• Shall prepare, from information provided by the district, claims for reimbursement of the costs of health and related services provided by the district’s employed or contracted professionals, to eligible students within the district within the definitions provided by the state services program and in the form(s) required by Medicaid.
• Forms for implementation may include but are not limited to:
o Claim forms
o In-service materials
o Sample letter to parents
o Doctor’s orders
o Supervision verification forms for speech therapy
o Other forms as needed
- Claims validation
• District a capability to validate claims per the rules and regulations issued by Medicaid and the state services program so that the district can be assured that prepared claims meet all required criteria.
• Such criteria include, but are not limited to, IEP specificity, physician concurrence, and provider certification.
- Denied claims
• Comprehensive follow-up program of denied claims, including but not limited to standard claim denials and third-party insurance denials.
- Claims and services summaries
• Summaries of claims filed
• Claims accepted
• Claims denied
• Unresolved claims
• Claims paid on behalf of the district for the period and cumulative for the year.