The Vendor is required to provide for a comprehensive, web-based, secure, and configurable software solution (“solution”) to automate and manage all aspects of preschool special education (“preschool special education”) including student data, evaluation information, service provision, provider information, provider billing, and medicaid billing functionality, in full compliance with federal and state regulations.
- The solution must provide seamless data exchange between the county, school districts, and special education preschool providers.
- Solution shall include:
• Secure communication and data exchange between the county, school districts, and service providers.
• Digital submission and tracking of agency forms and provider session notes.
• Integration with department systems and medicaid billing platforms.
• Seamless upload of all agency entries to department for approval and generation of agency id numbers.
• Agency issue research tools for direct resolution between the county and department through the software solution.
• Use of agency data for ongoing service tracking and invoice generation.
• An interface for the county to analyze data and monitor compliance with federal and state regulations.
• Download and integration of department tuition rates and rate adjustments.
• Notification tools to alert the county of AVL claim status.
• Direct processing and upload of AVL claims through the software solution.
• Tools to research unclaimed payments and problem claims within the solution.
• Ability to compile necessary data and reports required for annual state claims.
• Ability to identify preschool children who are scheduled to receive services.
• Workflow rules must provide that forms cannot be finalized until all required information has been entered correctly.
• Medicaid claiming functionality. - The solution shall provide a secure, role-based system that enables preschool evaluators, related service providers, agencies and educational programs (“providers”) to:
• Upload and update relevant documentation associated with provider profiles (i.e. license renewal forms).
• Upload prescriptions for services and/or evaluations, as required by medicaid and department.
• Create and submit digital service orders, such as those entered by speech-language pathologists
(SLPS) for speech therapy.
•submit and manage session notes in a fully paperless workflow.
• generate billing claims directly through the solution, based on recorded sessions, for respective
Categories i.e.:
1. Individual related service providers.
2. Evaluators.
3. Center-based preschool programs.
- The solution shall provide center-based preschools and related service Providers with dedicated tools to:
• Enter and manage classroom attendance records.
• Link classroom attendance with billing entries for daily and/or monthly reconciliation.
• Track IEP service mandates against classroom delivery models.
• Generate medicaid and/or county reimbursement claims based on attendance and session data in billable related services.
- Provide medicaid billing functionality to include, but not limited to the following:
• Track medicaid status of children, identify and monitor services each medicaid-eligible child is scheduled to receive, reconcile, process and submit medicaid billing for services provided to eligible students in compliance with medicaid guidelines.
• Validate provider and student eligibility.
• Track status of providers and billing personnel by checking the required exclusion processes.
• Analyze provider service documentation to determine what services are billable to medicaid.
• Prepare and submit requests to providers for service documentation required to support medicaid claim.
• Review service data and follow-up with providers if documentation is not received or is incomplete.
• Produce the medicaid claim in accordance with agency and department policies and procedures.
• Submit medicaid claims directly to emedny exchange.
• Track all medicaid claims and payments.
• Reconcile medicaid payments, denials and pending claims against submitted claims.
• Track claim denials, rejections, and reimbursements.
• Provide error resolution tools and audit trails.
• Provide training to providers to facilitate understanding of program requirements.
• Produce management reports for the county.
• Provide regular consultation with department staff.
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: May 19, 2025