Medicaid Billing Services

The Vendor is required to provide Medicaid billing services a documentation program that can track the delivery of health-related services and submit claims to Medicaid for allowable services provided.
- Medicaid documentation
1. Eligibility:
•    Student age, 3 years to 21 years
•    Student has a Medicaid covered service listed in their document medical necessity (“DMN”)
2. Documented medical necessity (“DMN”):
•    DMN covers billing on the claim
•    Services rendered match the services rendered in the DMN
•    CPT and HCPCS codes match the DMN
3. Rendering and supervising providers:
•    Provider licensure and supervision of rendering provider when necessary
•    Provider signature(s) and date
•    Label indicating the rendering provider and the supervising provider
•    Electronic signature
4. Clinical notes – must include
•    Student’s name
•    Type of service rendered
•    Date service was rendered
•    Duration of time spent rendering the service
•    Clinical description of services rendered
5. Skilled nursing service documentation
•    Must ensure skilled nursing is billed correctly in fifteen (15) min increments.
•    Student eligibility at different times of the year
•    Parental consent to bill
•    CPT and HCPCS codes
•    Icd-10 diagnosis code
- Claim submissions and management
•    Capability must include current and active ability to submit claims to state Medicaid directly through UHIN tool using HIPAA compliant software required electronic submission signature 
•    Meet all state and federal requirements 
•    Exportable claims management reporting 
•    Reporting to allow for claim status inquiries to include “paid”, “denied”, or held service claims 
•    Ability to correct and resubmit claims 
•    Health insurance portability and accountability act (HIPAA) compliant with data collection and electronic data sets to meet HIPAA standards.
- Software features and capabilities
•    Current integration with PowerSchool. 
•    Must fully integrate with PowerSchool by linking to agency PowerSchool API for seamless, secure data exchange; read and write-back capabilities allow frequent (daily is preferred) bi-directional data integration with PowerSchool. 
•    Must be fully web-based, be accessible on mobile devices, and be compatible with screen readers and WCAG compliant. 
•    Application hosting services provided by offeror. 
•    Auto save features for all areas of the program. 
•    Ability to schedule and enter data for individual and group sessions. 
•    Calendar features to plan and schedule future sessions. 
•    Workflow capabilities which direct the user to complete required information or steps. 
•    Ability to create a caseload per staff member, school and with students able to be assigned to more than one caseload. 
•    Ability to view related services caseload in one place and screen and easily enter services. 
•    Compliance reporting capability. 
•    System has a full audit trail with date and time stamp showing all updates to information and user access l
•    Customizable employee access based on the level of access needed (by role or location) 
•    Ability to set separate school calendars for each school and campus to reflect different schedules for each (currently 7 separate schools). 
•    All information is updated in real time.
•    Integrated spelling and grammar checks. 
•    Provides error messages that are user-friendly and advise of possible corrections.
•    System can automatically inactivate students who unenroll from school and reactivate students who re-enroll. 
•    Will store and provide access to information for the duration of time required by Medicaid for record retention – five years from the date of payment. 
•    Use the agency student number as a unique student identifier where required.
- Customer service and training
•    Must have a 24-hour response time or less with technical difficulties.
•    Provide a direct contact for agency to interface with on issues, training, reports and all other processes.
•    Frequent collaboration meetings with our coordinators and direct contact.
•    Live technical support during regular business hours for all staff via toll-free number or via helpdesk using chat or email.
•    Online user guides and support accessible to all users.
•    Must provide a user manual specific to the actual program and module.
•    Online training modules available for all new users throughout the contract.
•    Training must be accessible to those who are blind, low vision, deaf or hard of hearing.
- Maximum contract budget is $30,000.00 per year for a total of $150,000.00