Medicaid Third Party Provider Services

The Vendor is required to provide Medicaid third party that will full administration for its Medicaid reimbursement claims program.
- Direct service claims Medicaid reimbursement
• District intends to enter into a contract with a company(s) that will provide full administration for its direct service claiming (DSC) program.
• Demonstrate a commitment to pursue the full claims potential of the health-related services provided by district personnel, both employees and contracted personnel.
• The system shall track any billable services with the state school based Medicaid claiming program.
• Provide the availability of experienced consultants to represent and accompany district officials in meetings with all local, state, and federal government agencies related to the operation of this program; to include full support and on-site assistance, if needed, in any and all audits of the DSC program
• Develop and submit a time schedule for: frequency of training, timeliness of responses, and length of time from receipt of provider documentation to reimbursement check being issued to district.
- Requirement:
• On-going training, as deemed necessary, for district administrators, staff and parents, including assistance with the parent consent process.
• Resource back-up support of all district personnel involved with the district program.
• Prepare and distribute all materials necessary for practitioners to record the services they deliver, including transportation staff.
• Complete claims processing, denial research, and remittance reconciliation of all claims.
• Report generation that will direct
• Assist with related services for non-special education students.
• Free care for non-special education students may be covered under the umbrella of the state school based Medicaid claiming program, along with IEP services.
• Assistance and phone calls within 48 hours.