The vendor is required to provide statewide, cloud-based, interoperable and comprehensive electronic health record (HER) and Medicaid billing system for schools that fully integrates with infinite campus (IC), the student information system (SIS) used by agencies.
- Core requirements:
1. Medicaid billing and claims management
a. The selected system shall:
• Automate claim submission to division, with built-in validation checks to reduce errors before submission.
• Ensure compliance with Medicaid billing and coding standards, including:
o Icd-10 for diagnostic coding
o CPT for medical services, procedures, and tests.
o SNOMED state for standardized clinical terminology.
o LOINC for laboratory and health measurements.
o National drug code (NDC) for medications administered in a school setting (e.g., vaccines, asthma medication
b. Validate claims across multiple compliance checkpoints, including
• Active IEP and health services plan within allowable dates.
• Tracking of parental consent to treat (annual or in the event of changes in plan of care).
• Tracking of parental approval for release of information to Medicaid for billing (one time).
• Verification of provider credentials and service scope to ensure rendering provider is working within current scope of practice and licensure/certification; lea shall continue to be listed as both furnishing and billing provider on billing claim form.
c. Enable batch processing and bulk claim submission to maximize efficiency.
d. Ensure all Medicaid-covered services are documented in an audit-ready format.
e. Allow for real-time claims tracking features, including status monitoring and proactive resolution mechanisms.
f. Enable integration with the Medicaid management information system (MMIS) for seamless data exchange and reporting (DDI phase).
2. Information security and privacy requirements
• Given that this system handles sensitive student health data, vendor shall implement and maintain robust security and privacy controls in compliance with all applicable federal and state regulations
• Provide comprehensive documentation demonstrating compliance with security and privacy requirements. such documentation shall include, but is not limited to, a security plan, disaster recovery plan, business continuity plan, and data sharing policies
• Provide detailed API security standards, access control policies, encryption methodologies, incident response procedures, and compliance attestations
• The system shall employ industry-standard encryption protocols for data at rest and in transit, enforce strict role-based access controls, and incorporate multi-factor authentication to prevent unauthorized access
• Provide detailed documentation of its authentication, authorization, and audit logging mechanisms to ensure continuous monitoring and accountability.
• Provide comprehensive incident response and breach notification plans, including defined reporting timelines, mitigation strategies and documented measures for identifying, mitigating, and addressing any single points of failure.
• Provide data retention and destruction policies, ensuring compliance with federal and state laws.
• All data processed, stored, or transmitted through the system shall remain the sole property of the state, and vendor shall not use, disclose, or retain such data beyond the scope of this contract without explicit written authorization
3. Integration with infinite campus (IC) to eliminate redundant data entry
• A top concern reported by leas is the burden of duplicate data entry across multiple systems, increasing workload and risk of errors. reducing manual entry lowers administrative burden minimizes human errors and ensures data consistency across Medicaid submissions
• Automatically pull student demographics, Medicaid eligibility, and service records from ic, if such information is stored by a lea in IC.
• Sync attendance and service logs to verify Medicaid eligibility prior to claims submission
• Ensure real-time updates between IC and the electronic health record (HR) system to prevent discrepancies in student records
4. Medicaid compliance support, encounter chart templates, and state interstation
• Many leas struggle with Medicaid documentation and compliance requirements, which can result in claim rejections, funding recoupments, and administrative audits. leas need structured, standardized documentation tools to reduce administrative burden, improve billing accuracy, and support Medicaid compliance
• The selected system shall
a. Medicaid documentation and compliance tools
• Provide pre-configured templates for Medicaid-covered services to standardize documentation.
• Automate tracking of parental consent to treat and alert staff when re-consent is required.
• Automate tracking of parental approval for release of information to Medicaid for billing.
• Support documentation and compliance tracking for 504 plans, health service plans, and other non-IEP services.
• Include audit-ready documentation features to ensure compliance with Medicaid and FERPA (family educational rights and privacy act) regulations.
b. Encounter chart templates for efficiency & knowledge sharing
• Allow leas to create, customize, and share structured encounter chart templates.
• Enable real-time collaboration on service notes across providers and teams.
• Pre-populate key data fields to reduce repetitive entry and improve workflow efficiency
• State integration for immunization records
a. Direct access to state eliminates the need for manual immunization record requests, improving efficiency and compliance.
• Enable direct integration with state, the state's immunization registry.
• Allow school health providers to query and retrieve student immunization records in real-time.
• Ensure immunization records are automatically updated in the EHR system to prevent duplicate documentation
5. Reporting and analytics
• To effectively monitor the provision of school health services (SHS), leas shall be able to collect, aggregate, and analyze data.
• To arrive at actionable insights, leas shall also be able to easily create reports customized to their unique needs.
• Modern EHR systems are expected to offer robust reporting and analysis capabilities.
• These features enable leas to monitor performance, identify areas for improvement, and make data-driven decisions.
• The selected system shall:
o Provide encounter and reimbursement reporting.
o Provide a detailed description of its approach to data anonymization and de-identification methodologies utilized in report generation.
o Implement and maintain appropriate safeguards to ensure that all personally identifiable information (PII) remains protected and is not exposed through reporting tools.
o Enable user-friendly trend analysis.
o Support ad hoc reporting and interactive dashboard development.
o Allow leas to easily access and utilize their data.
6. Training and technical assistance support for leas and relevant stakeholders
• Leas have emphasized that comprehensive training and ongoing support are critical for adoption and effective use of the system. this ensures staff confidence, accurate Medicaid billing, and reduced administrative burden.
• Initial training and implementation support requirements:
o Develop and deliver a structured training program to support the initial system implementation for all participating leas.
o Provide security awareness training for leas on data privacy and handling of sensitive health information.
o Provide customized training modules based on user roles (e.g., school nurses, therapists, administrative staff, billing personnel).
o Provide ad hoc support related to procedure and billing processes.
o Offer live, interactive training sessions (in-person) to ensure end-users fully understand system capabilities.
1. Provide on-demand training resources, including video tutorials, user guides, and FAQs.
• Ongoing technical assistance and user support
o Establish a dedicated help desk with real-time user support available via phone, email, and chat.
o Implement a ticketing system for tracking technical issues and resolution timelines.
o Offer quarterly refresher training sessions to accommodate system updates and new staff onboarding.
o Ensure timely (i.e., within one business day) availability of technical specialists with appropriate subject matter expertise to assist with Medicaid billing, claim validation, and compliance workflows.
o Include tools or processes that facilitate regular collection and analysis of user feedback.
• System updates and advanced user training
o Provide regular training updates as new features, compliance requirements, or billing policies are introduced.
o Conduct advanced training for leas that require more in-depth guidance on reporting, analytics, and data integration.
o Include train-the-trainer programs to enable designated school personnel to serve as internal experts on the system.
7. Recommended enhancements:  Medicaid managed care integration (optional – where applicable)
• SHS Medicaid billing is carved out of managed care in state, meaning Medicaid managed care organization (MCO) integration is not a requirement for leas.
• However, some schools partner with federally qualified health centers (FQHCS) or school-based health centers (SBHCS) that contract with MCOS. for those leas, the system should:
• MCO integration (optional)
o Enable encounter data reporting for schools contracting with MCOS.
o Support electronic prior authorization requests for services requiring approval.
o Allow tracking and coordination of Medicaid -referred services.
• While not required for Medicaid SHS billing, MCO capabilities would allow for direct contracting and alternative reimbursement models for schools that pursue these partnerships.
8. System structure:  a system that levels the playing field for SHS staff
• By structuring the EHR and Medicaid billing system around lea priorities while allowing for future expansion, this ensures that SHS staff are no longer at a disadvantage in engaging with Medicaid while ensuring long-term funding sustainability.
• This system shall:
o Reduce administrative burden and increase Medicaid billing accuracy.
o Provide a unified platform where physical health, behavioral health, and individualized education program (IEP) services can be documented.
o Ensure compliance with relevant plan of care requirements (e.g., idea, IEP), including tracking of parental consent to treat and approval for release of information to Medicaid for billing.
o Enhance care coordination with community-based providers (optional).
o Support integration with state for real-time immunization access
- Contract Period/Term: 4 years
- Questions/Inquires Deadline: April 22, 2025