Medicaid Billing Services

The Vendor is required to provide for the exclusive provision of web-based, fee-for-service medicaid billing to facilitate agency participation in the medicaid reimbursement program.
- Reimbursement for certain health related services such as speech-language therapy, occupational and physical therapy and nursing services, which are provided to students with disabilities through an Individualized Education Program.
- Services include:
•    Providing support for medicaid audits.
•    Providing an operation plan.
•    Run billing on a day-to-day basis, not less frequently than once a week.
•    The offeror will assist individual providers (contract or staff) in obtaining individual NPI numbers.
•    Must have an internal database which is to be 5010 (HIPAA) compliant and able to accept icd-10 formats (diagnosis codes).
•    The offeror shall establish a system for reconciling submitted medicaid claims with receipts and credited payments.
•    The offeror shall assist agency in reviewing student files to check for medicaid compliance; including identifying areas of improvement and executing a plan to address the needs accordingly.
•    Provide and maximize services rendered to medicaid eligible students under the terms and conditions specified in the district's contract with the department health
•    Provide an implementation timeline, including rollover student data and staff training. 
•    Optimize revenue gathered through delivery of those services. 
•    Work with the department health and the district in obtaining rates to secure maximum reimbursements.
•    Provide a system to identify medicaid-eligible students and increase the level of participation in the medicaid reimbursement program using the most advanced electronic medicaid eligibility verification methods available.
•    Provide and implement standard documenting procedures for service providers.
•    Provide review and revisions, as needed, of current district specific internal processes, procedures and forms for ongoing identification of medicaid-eligible children, documentation and tracking required to maintain a clean service delivery and billing audit trail with medicaid policies and procedures.
•    Provide secure electronic Medicaid records to reduce liability for individual users and District.
•    Provide a Transition Plan for possible future vendors.
•    Provide documentation components required by state and federal law for school-based services (i.e., controlled medication counts, medication logs, and individual education plans (IEP), templates, form letters and referral letters to include tracking mechanism components, daily logs of student encounters and daily items logged.)
•    Comply with and keep apprised of current FERPA, HIPAA and confidentiality requirements by Medicaid and state federal entities.

- Contract Period/Term: 5 years
- Questions/Inquires Deadline: September 10, 2025