Medicaid Claiming Services

We develop Medicaid claims to recover the eligible costs that School Districts incur in providing Federally-mandated, health-related services to Special Education students - and their eligible administrative costs. In doing so, we develop claims that are accurate and complete - and that will "Pass" any subsequent Federal or State audit or review (We strive to ensure that all of our School District clients are "Audit Ready" at all times).

We believe that there are three (3) pre-requisites for developing accurate Medicaid claims for School Districts: i.e., a detailed knowledge of the Title XIX/Medicaid program and the Title XXI/State Children's Health Insurance Program; accurate and timely records concerning the health-related services that have been provided; and attention to detail. In addition, we also believe that the key to ensuring that those pre-requisites are always met is having locally-based staff who can meet with - and provide training to - School District staff on a regular basis.

In order to be valid, every Medicaid claim for school-based health services requires the following elements:

• an eligible Medicaid recipient;
• an appropriate authorization or prescription that is consistent with the student's "Individual Education Plan";
• an authorized Service Provider whose "Licenses"/"Certifications" are current and appropriate for the service being delivered; and
• detailed documentation of the service that was provided.

All of the staff who are involved in the claims development process are trained by ESP's Senior Staff. Thereafter, they also participate in ongoing reviews and discussions on a regular basis.

We have also established an internal Quality Control Unit whose sole function is to review - and evaluate - a representative sample of each School District's Medicaid claims. These reviews help to ensure that each School District's claims are developed in accordance with all of the applicable Federal and State guidelines - and in accordance with our internal processes and standards.

In addition, staff from our Quality Control Unit periodically undertake internal comparative analyses of the Medicaid claims that we develop for all of our School District clients. By doing so, we are able to detect variances among various School Districts' claims - and develop strategies that will allow all of our School District clients to properly maximize their Medicaid claims.