The vendor is required to provide the school system to develop and support a third-party billing service for students with disabilities who are medicaid eligible for the department services and the division of business, fiscal, and information systems.
- Initiate and maintain all components of the billing system and process for services rendered.
- Produce record keeping forms and other elements as needed.
- Enter, edit, correct errors, and transmit claims to state medicaid for payment.
- Generate audit reports for claims submitted for payment; provide spreadsheet files and hardcopy.
- Maintain files of required information on each client.
- Meet requirements of state department of health, center for medicare/medicaid services, affordable care act to file claims electronically.
- Receive and file claims on a schedule of agency choosing.
- Act as a liaison between agency and the state regarding medicaid billing policies and regulatory changes
- Review the weekly state explanation of benefits remittance advice report and work with agency to reconcile and correct denied claims for future payments.
- Assist with reconciliation of all denied claims with reasons specifically related to the medicaid provider status and further steps needed by agency and/or the provider to correct and update the application status in the state electronic provider revalidation and enrollment portal or otherwise to prevent potential loss of funding.
- Maintain an integrated billing system that allows for direct data import.
- Allows for services logged to be submitted and processed automatically.
- Provide a third-party dedicated staff member to agency to assist with reconciliations, billing questions, technical needs, provider analysis, and customized reporting needs.
- Maintain a billing system that allows flexibility related to user roles assigned to student profiles.
- Provide initial professional development and ongoing training to address system updates.
- Contract Period/Term: 3 years
- A Virtual Pre-Proposal Conference Date: March 25, 2025
- Questions/Inquires Deadline: March 19, 2025