School Based Health Services Medicaid Claims Processing
During the period 1991 through 2002, MSF&W performed Medicaid claims processing services for several of the largest school districts in the United States. This system tracked the school-based health services delivered to special education students and created an electronic claim for submission to the State Medicaid Agency. All reimbursements flowed back to the corresponding school district because they were registered as Medicaid providers.
This system was implemented in the following large independent school districts:
| Michigan | Illinois | Delaware | |
|---|---|---|---|
| Dallas | Detroit (16 ISDs) | ISD | All 13 ISDs |
| Ft. Worth | Flint | ISVI | |
| San Antonio (4 ISDs) | Grand Rapids | ICRE | |
| Judson | Lansing | ||
| SpringBranch | Macomb Co. |
MSF&W established the standard data submission and reporting requirements for each district and received and processed the following information from each district:
- School data
- Student demographic data
- Student attendance data
- Student transportation data
- Clinician credential data
- Clinician student caseload data
- Clinician school assignment data
- Clinician daily service delivery data
MSF&W developed and operated the system for each district and performed the following services:
- Accept input files of data from each district
- Massaged the data for use by the system. This included removing non-alphanumeric data from student names, creating a unique identifier for each student, building linkages between students and schools where they were being served, building linkages between students and the clinicians that served the students, building linkages between clinicians and the schools where they worked and the programs they served.
- Determine Medicaid eligibility for each student by matching the student name, date of birth, gender and county of residence with the State Medicaid Agency’s databases. For each matched record, we obtained the Medicaid number, the dates of eligibility and any third party insurance information.
- Process daily units of service reported by each clinician throughout the year.
- Edit each unit of service transaction for completion and duplicity of service to guard against submission of duplicate claims.
- Format electronic claim for submission to the Medicaid agency for reimbursement
- Receive and process electronic Medicaid response files indicating acceptance or rejection of the request for Medicaid reimbursement.
The electronic interfaces with the Medicaid agencies conformed to national standard reporting requirements in place at that time. These reporting requirements established the foundation for the creation of the HIPPA reporting requirements now in place.
The services provided by MSF&W on this project were performed under the security and privacy regulations that existed during this timeframe. Privacy of student data was maintained within our processing center through the use of restricted system access controls.
