Third Party Medicaid Billing Services

The Vendor is required to provide third party Medicaid billing services beginning with the 2026-2027 school year.
- Requirement:
• Have the capability of providing the district with a Medicaid eligible notification or alert system
• Have the capability to accept and process both electronic and hardcopy service tickets for filing claims.
• Random moment in time training and tracking support.
• Prepare and submit quarterly claims for Medicaid administrative claiming (“MAC”)
• Ensure a quality management system that includes, but is not limited to:
o Demonstrated ability to consistently provide products that meet customer and applicable statutory and regulatory requirements; and
o Aim to enhance customer satisfaction through the effective application of the system, including processes for continual improvement of the system and the assurance of conformity to customer and applicable statutory and regulatory requirements.
• Have an internal systemic capacity of validating all services requirements for billing to include, but not limited to, the following and provide documentation (upload on response attachments tab):
o Parental consent to bill
o Existence of a current IEP
o IEP that authorizes the frequency and duration of school health and related services
o Verification of licensure and certifications for all service providers
o Verification of prescription for services provided to students
o Medicaid eligibility at various times of the year.
• The above district personnel with continuing education hours (CPE)
• Claims on a timely basis, as determined by the district, provide notification when claims have been submitted, and repeatedly resubmit rejected claims, as necessary, to obtain alignment with floating Medicaid eligibility periods.