Medicaid Billing and Nursing Documentation Services

The Vendor is required to provide nursing documentation system must provide a comprehensive, integrated platform that supports clinical documentation, Medicaid billing, data management, and administrative oversight across all schools in the district.
- Clinical nursing and IHP module:
1. Medicaid billing integration
• The system must fully integrate Medicaid billing within the nursing documentation platform.
• It must support the use of appropriate icd-10 and HCPCS codes through customizable templates.
• Billing functionality must include:
o Start and end time tracking for visits to determine billing units.
o Algorithms to manage Medicaid id numbers, consent status, and revocation dates sourced externally.
o Administrative control over billing templates and coding structures.
2. Clinical documentation capabilities
• The system must support comprehensive nursing documentation, including:
o Mental health records
o General nursing documentation
o Risk management documentation
• Documentation must:
o Be structured by body systems
o Include notes and comments per visit
o Capture visit disposition
o Incorporate individual health care plans (IHCPS)
3. Student data management
• Provide centralized access to both current and historical student health records.
• Ensure indefinite retention and accessibility of records for all past and present students.
• Allow:
o Import of existing immunization records across the district
o Import of chronic condition data (e.g., allergies, asthma) with visible student identifiers
o Processing of all student data, including inactive and pre-enrolled students
o Support daily updates to remove withdrawn or transferred students from active census.
o Utilize enrollment dates to prioritize insurance records.
4. Immunization and health tracking
• Track immunization compliance in alignment with DHEC annual updates.
• Monitor and report:
• Screening outcomes (grade level, pass/fail, referrals)
• Chronic illness needs
• Communicable disease trends
5. Scheduling and care planning
• Enable scheduling of medications and procedures with a daily care plan view.
• Ensure substitute and float nurses can easily follow assigned plans.
• Allow substitute nurses to independently select single-school assignments.
6. Reporting and analytics
• Consolidation of up to ten productivity metrics across all schools in monthly and annual reports in csv or excel formats
• Health room utilization data
• Ensure compliance with mandatory reporting requirements (e.g., nurse grant under the student health and fitness act).
• Allow supervisors to review large volumes of documentation across multiple schools in a single report.
7. Administrative controls
• Provide role-based access with customizable permissions and visibility.
• Allow administrators to:
o Manage templates (billing, visits, documentation)
• Add and delete medications
• Control user access by school and assignment
• Ensure examiners and staff only access assigned students and schools for the day.
8. Data import and system integration
• Monthly import of student images (up to 6.2 GB)
• Granular import error reporting (parsing and soft errors)
o Maintain compatibility with external data sources for Medicaid and student information.
9. Communication and accessibility
• Integrated parent portal for communication
• Real-time messaging within the system for all users
• Provide clear customer support access and service descriptions for administrators.
10. Medication and inventory management
• Support medication administration documentation with optional inventory tracking.
• Allow enabling or disabling of inventory features as needed.
11. Audit and compliance
• Maintain an integrated, easily accessible audit log of all system activity.
- Medicaid billing module:
1. Data exchange and claims processing
• Support automated import and export of standard HIPAA electronic transaction files, including:
o 270/271 eligibility inquiry and response transactions
o 837 claims submission transactions
o 835 electronic remittance advice (era) transactions
• Provide the ability to void, correct, and replace submitted encounters and claims.
• Allow entry and management of encounters for all students, regardless of Medicaid eligibility status.
• Support automated claims workflow processing and status tracking.
2. Eligibility verification and student management
• Perform monthly Medicaid eligibility identification using the district’s complete student roster.
• Identify, track, and maintain records of students with current parental and guardian consent for Medicaid billing.
• Maintain historical billing, encounter, and reimbursement data for periods exceeding one (1) year.
• Provide functionality to manage student demographic and enrollment data necessary for Medicaid billing compliance.
3. System integration and data population
• Integrate with external district systems and data sources, including but not limited to:
o IEP/504 management systems
o Clinical nursing documentation systems
o Therapy and treatment note systems
o Student information systems (sis)
• Automatically populate required billing fields using available integrated data sources to reduce duplicate data entry.
• Integrate with district and school calendars.
• Provide functionality for recording and tracking student attendance and absences.
• Allow configuration of billing units and service parameters based on user role, provider type, or discipline.
4. Error validation and workflow management
• Provide real-time billing validation and error checking prior to claim submission.
• Identify duplicate billing and other billing conflicts before claims are transmitted.
• Allow users to independently correct billing errors without requiring re-entry of the original encounter or service event.
• Support audit tracking and change history for billing corrections and claim modifications.
5. Reporting and analytics
• Customizable reports by:
o Provider and examiner
o School
o Service type
o Billing status
o Date range
• Export options in multiple formats, including:
o Csv
o Excel
o Pdf
• Real-time billing reports and dashboards.
• Detailed remittance reporting from 835 files, including:
o Check and payment information
o Claims billed
o Claims adjudicated
o Claims paid and denied
6. Notifications and compliance management
• Include a configurable reminder and notification system at multiple organizational levels, including:
o Therapist and clinician
o Supervisor
o District administrator
• Generate, store, and manage all required Medicaid billing forms and compliance documentation, including:
o Consent forms
o Service documentation
o Audit-related records
• Support secure document retention and retrieval in accordance with applicable state and federal regulations.