December 2017

Description: Madison-Oneida BOCES employs Medicaid data entry experts who provide assistance school districts to maximize Medicaid reimbursement for eligible special education services. BOCES staff are well versed in Handbook 8 and attend all NYS required Medicaid trainings. They have thorough knowledge of the Medicaid claiming process, including service eligibility, documentation retention and auditing requirements on behalf of school districts. The service is a collaborative effort between BOCES staff and the district's CSE Medicaid designee.

Goal: Maximize available Medicaid revenue for participating districts.

Evaluation: Periodic reviews of Medicaid reimbursement revenues received by participating districts, compared to expected revenue based on submitted claims data.

Role of BOCES:

• Review the existing classified students, eligibility, non-matched, inactivated students, and deletion reports.
• Complete and submit all required reporting and claim forms for Medicaid. Assist in the claiming for Medicaid services and file for any retroactive unclaimed funds to the extent allowed by law.
• Run an exception report on a monthly basis. Reconcile missing documentation.
• Respond to all requests for information from any and all auditors as related to Medicaid processing.
• Provide monthly reports as requested by the District.
• Document the Medicaid claim process.
• Review all district forms and procedures and make recommendations as needed to ensure compliance with State and Federal Medicaid Guidelines.
• Submit monthly claims for Medicaid Claims. Submittals will be within 30 days (plus or minus to coincide with the SSHSP calendar) following the last day of the previous month if all documentation is provided to Madison-Oneida BOCES in a timely fashion between cycles.
• Provide monthly reports of missing information from District and non-district service providers.
• A monthly reconciliation of claims processed compared to files generated to insure a system of checks and balances.
• Review Medicaid providers periodically to ensure they do not appear on the Medicaid exclusion list.
• Monitor new developments or changes in State and Federal laws and inform the District.
• Provide professional guidance and overall (plan) management services.
• Complete, upon request, and on behalf of the District any and all reporting requirements.

Role of District:

• Review and certification of remittance files.
• Supply all necessary documentation and/or access to electronic data.
• Retain original documentation as required.
• While the service will identify missing claim information, monitor and inform the district of changes in state and federal regulations, and the like, it is the responsibility of the district to follow up with its staff to provide complete information and determine the impact of new Medicaid policies or procedures.
• The district must review the role and duties of the regional Medicaid support services provider that is contracted through the New York State Education Department and ensure that there is no duplication of activities.
• Utilization of ClearTrack or IEP Direct software in processing Medicaid data; provide Madison-Oneida BOCES staff with software licenses and any software updates.

Costs:
$43.70 per hour (2017-18 rate)

Districts are billed based on usage. Support is unique based on district need (use of teacher interface, backlog as of commencement of service, etc.).

Medicaid Support Staff:
Cherie Spraker, Sr. Administrative Assistant 315-361-5822 [email protected]
TBD, Asst. Data Processing Coordinator 315-361-5833

Services currently provided under SED contract with the RIC:

• Update and train district staff on changes to Medicaid regulations as necessary
• Coordinate SSHSP training for new relevant employees
• Provide training and technical assistance on Medicaid software systems and related reports
• Coordinate mandatory annual compliance training
• Act as liaison among the providers, NYSED and CNYRIC
• Conduct site visits (Audit 20% of region)