Components of the MSBP include, but are not limited to: • Assist and provide monthly eligibility validation. • Perform billing application updates, enhancements, changes per state regulations. • Upload physician orders, referrals, and prescriptions throughout the school year. • Extract federally funded staff during the pre-billing process to eliminate these employees from the billing pool. • Demonstrate the ability to maximize reimbursement revenue. • Submit claims for billing. • Provide full-service, school-based billing, management, and reporting for school-based Medicaid. • Provide Medicaid billing services and pre-billing checks for: o Targeted Case Managers o School Social Workers Nursing o School Psychologists o Occupational Therapists o Physical Therapists o Speech & Language Pathologists o Transportation o Personal Care o Student Medicaid ID o Age Requirement o Diagnosis Code o Documentation of Medical Necessity o IEP/IFSP Plan of Care Dates o Referral/Order Physician Authorization o Supervisor Sign-Off o Verification of Parental Consent o Transportation o Non-School Days o TCM with No Direct Service • Demonstrate the ability to use compliance checks to meet service provider documentation requirements according to state and federal guidelines. • The MSBP must meet the state and Medicaid billing requirements. • Retrieve readmittance (RAs) to help identify claims the state has rejected to determine the reason and needed corrections for resubmission. • Collect and identify missing documentation from service providers (monthly summaries, supervisor signature etc.). • Collect and identify missing documentation for compliance (scripts, parent consent, expired IEP). • Monitoring of the 85% delivery of service claim rule. • Reports easily printed with important billing data which can be filtered to review student information per teacher. • Provide billing platform that meets federal and state Medicaid billing requirements. • Extract federally funded staff from billing submissions. • Must have the capacity to house academic logs.
