Third-Party Medicaid Billing Services

The Vendor is required to provide third-party Medicaid billing to Medicaid administrative claiming (mac) and school health and related services (SHARS) services in person and via a secure web-based platform for Medicaid billing for an estimated 500-600 students.
- Requirement:
•    Assist with data entry for SHARS claims as requested by agency.
•    Submit student information on a minimum of a monthly basis to state Medicaid and healthcare partnership (TMHP) for electronic eligibility match.
•    Support in the process of tracking parent consents for SHARS billing.
•    Assist with calculating direct medical services individualized education plan (IEP) ratio to include:
o    Total number of Medicaid students with IEPs requiring direct medical services and 
o    Total number of students with IEPs requiring direct medical services for the SHARS cost report as requested by agency.
•    Monitor and track occupational therapy (OT) and physical therapy (PT) referrals for compliance. 
•    Assist with Medicaid enrollment and complete management of mac financials as requested by agency. 
•    Maintain full support in the event of any internal and external audit, including conducting practice audits, providing documentation of processed claims, and writing necessary reports and correspondence.
•    Provide and agree to furnish all agency billing and related data as requested by agency. 
•    Provide ongoing review of district SHARS program and advice to maximize documentation of provided Medicaid services and related billing, including specialized transportation sessions and claiming. 
•    Provide data entry when needed by properly trained vendor staff, specifically in areas of transportation, health services, and residential sessions and claiming to reduce administrative burden on agency staff and maximize reimbursable claim amounts payable to the school. 
•    Serve as the primary SHARS cost report preparer in the state electronic provider system (steps) for each year of submission.