District Responsibilities
District Responsibilities
Reddy Consulting Services, Inc. in East Yaphank, NY, outlines the Medicaid reimbursement requirements for school districts as required by the Student Supportive Health Services Program.
A. Provide demographic information for all special education students and referrals
(to develop and maintain Medicaid Eligibility List)
B. Provide consultant with District:
1. BedsCode Number
10. Regional Information Center Number (RIC)
11. Provider NPI (National Provider Identification Number) Number
12. Current Medicaid Eligibility List and Non/Near Match List
13. Current Remittance Statements
14. District’s School Calendar(s) (for contractual period(s))
15. Statements of Re-assignments and Provider Agreements
16. Access to IEP Direct and CNYRIC MEDWEB and NYS Medicaid Report Website
17. Access to student file(s)for claiming information:
a. Annual Review, Initial IEP’s, Requested Reviews Triennials
b. Attendance Records
c. Evaluations -
1. Medical (s)
2. Medical Specialist
3. Speech
4. Occupational Therapy
5. Physical Therapy
6. Psychological (s)-Basic and Comprehensive
d. Student(s) Actual dates of service/Session Notes/Treatment Logs
e. Prescriptions/Referrals-
1. Skilled Nursing Services
2. Occupational Therapy
3. Physical Therapy
4. Speech
5. Psychological Counseling
6. Evaluation(s)
f. Progress Notes
g. Referral(s) for students not classified but evaluated
h. Medicaid Parental Consent(s)
C. Access to provider(s):
4. Credentials
5. Service/Treatment Logs
6. “Under the Direction of” Statement(s) (if there is no licensed speech pathologist on staff, then a letter of direction must be written by a licensed speech pathologist that he/she is available on a consultant basis for other speech teachers in the District; (i.e. Speech meeting minutes) and “Under the Supervision of” Statements for License Master Social Workers written by a Licensed Clinical Social Worker that he/she is available on a consultant basis for Licensed Master Social Workers with in the District (i.e. counseling meeting minutes)
D. Notify consultant of all Medicaid meetings with County, State and District(s) RIC, CNYRIC.
E. Access to Relevant Employee Annual Training Log.
Our Responsibilities
Our Responsibilities
A. Request District(s) BedsCode, Regional Information Center Number and Provider Number
B. Request current copy of the districts Medicaid Eligibility List and Non-Near Match List(s)
C. Prepare a list of all Special Education Students receiving related service(s)
D. Review Medicaid Eligibility List for “Additions and or Deletions”
E. Review Medicaid Non/Near Match List for “Additions”
G. Set up “Audit files” for each Medicaid Eligible student receiving a service(s). Audit file will contain the following items:
10. Check sheet with students name, date-of-birth, date(s)-of-eligibility, service(s), Date of ‘Signed” Medicaid
Parental Consents
11. Student’s Attendance
12. Students Session Log/Treatment Log(s)
13. Progress Notes
14. IEP’s-Annual Reviews, Initials, Requested, Triennials(s)
15. Prescription(s), Recommendation(s) and Referral(s) (if applicable)
16. Evaluation(s) (if applicable)
17. Signed Medicaid Parental Consent Letters
18. Miscellaneous memos
H. Send Provider Agreement and Statement of Re-Assignment Letters to all Subcontractor and Out-of-District Providers when received
sign place into Audit binder.
I. Print out copies of both In-District and Out-of-District Providers Credential’s and Medicaid Provider Status, place into District Audit
Binder.
J. Print all Session/ Treatment logs and Progress Notes. Compile a master list of all missing Medicaid information. Locate all data, update
missing list and furnish a copy to the Director of Special Education. Any missing or incomplete Student Attendance, Session/Treatment
Logs, Prescriptions, Recommendations and or Referral for services that are unobtainable from either “In-district” or “Out-of-District”
providers, shall be brought to the attention of the Special Education Director in writing for assistance in obtaining the missing
information.
K. Check all In-District and Out-of-District providers/Subcontractor against OMIG and OIG databases (monthly) for exclusions and
Medicaid Provider status (annually).
L. Review and process all information gathered. Input services into CNYRIC MEDWEB program (on behalf of the district) for processing
and MEDWEB control # will be issued by RCS. RCS will then obtain a “Signature of Release Statement” from the district.
M. Print out a copy of every MEBWEB claim (submitted on behalf of the district). Log the MEDWEB Control # into excel spreadsheet. The
MEDWEB Control # spreadsheet is updated each time a claim is submitted to CNYRIC for processing. The spreadsheet will be kept in
the following manner:
e. Date Medicaid Claim was submitted for processing
f. MEBWEB Control #
g. Dollar Amount of claim
h. Remittance Report Number(s), Amount Accepted, Actual Paid Amount, Pended Amount.
N. For every new and current Medicaid Eligible student(s) who is receiving a related service(s) (i.e. SP, NU, OT, PT, CO) and/or an
evaluation(s) (i.e. Audiological, Psychological, Medical(s), Medical Specialist and Special Transportation, may be claimed within the
statute of limitations (11 months back). Any prior service(s) and/or evaluations are ineligible.
O. One month after the MEBWEB claim has been submitted to CNYRIC for processing, RCS will receive notification that Remittance
Statements (paid, pended or denied reports) from CNYRIC for claims submitted are available. RCS will reconcile these reports and all
“Rejected transaction(s)” will be resubmitted immediately with changes. It usually is due to the “Parental Consent” not flagged.
“Held/Pended transaction(s)” are checked each month for payment. They are usually held due to “Manual Review” and paid, when
CNYRIC does a “Purge Run” (done on a quarterly basis). “Denied claims” are usually from service(s) claim prior to the 11 month period.
P. Attend all Medicaid meetings (County, State, Federal and District(s) RIC) and CNYRIC MEDWEB program meetings and report minutes
of the meeting(s) to the Director of Special Education and Director of Finance. This will allow both the consultant and Special
Education and Finance Department to minimize loss of revenues and notify District of all Medicaid updates and or changes via
Medicaid Alerts issued from NYSED.
Q. Consultant in conjunction with SED, DOH and OMIG will provide training sessions (when applicable) for the Special Education staff,
Finance staff and service providers. Consultant will forward any issued Medicaid Alerts, Q& A’s and or The NYS Medicaid Handbook(s)
and its revisions issued by NYSED to any Provider or Staff member (when requested). Answer any questions.
Confidentiality
Confidentiality
All identifiable students and staff information, reports and studies, obtained by or furnished to RCS by the Board, shall not be provided or disclosed to a third party without the written consent of the Board. RCS will limit access to such material in its possession to those of its employees performing service in pursuant of said agreement purely on a need-to-know basis. RCS shall restrict use of the information to its performance under all Agreements.
Contact us today at (631) 924-7922 or email us at reddyconsulting@optonline.net to see what we can do for you.
Note: All information and documentation provided by and/or pertaining to Reddy Consulting Services, Inc. (RCSINC) is Trademarked and Copyrighted. Any unauthorized use of this information is subject to prosecution to the fullest extent of the law.