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Mike Laliberte
Director of Business Services
Telephone: (781) 878-6056, ext. 105
MLaliberte@nrcollab.org

Kelli McPherson
Medicaid Specialist
Telephone: (781) 878-6056, ext. 111
kmcpherson@nrcollab.org

Margie Kenney
Medicaid Specialist
Telephone: (781) 878-6056, ext. 155
mkenney@nrcollab.org

 

198 Spring Street Rockland, MA 02370 - Phone - 781-878-6056 Fax - 781-982-9787
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Municipal Medicaid Reimbursement

Introduction

School Based Medicaid Billing has become a way for cities and towns to recoup dollars for money spent on special education programs if a student is receiving special education services and is eligible for MassHealth. The School Based Medicaid billing program consists of three components:  Direct Services Claiming (DSC),  Administrative Activities Claiming (AAC) and the Annual Cost Report.

Direct Services Claiming (DSC) provides school districts an opportunity to be reimbursed for furnishing medically necessary services to eligible MassHealth students pursuant to an eligible IEP. NRC offers online document and reporting applications for Medicaid billing customers.

Administrative Activities Claiming (AAC) allows school districts to be reimbursed for participating in activities that support the administration of the state’s Medicaid program. North River Collaborative is familiar with both school and town governance and aware of confidentiality and privacy issues, including HIPAA and FERPA, as well as the necessary record keeping required by districts, towns, and the Office of Medicaid.Cost Reporting reconciles 12 months of direct service and administrative actual cost.

History

North River Collaborative (NRC) implemented School Based Medicaid Direct Service Reimbursement for cities and towns in 1993 and became a pioneer among collaboratives in coordinating and providing these services with the Commonwealth.

NRC coordinates the School Based Medicaid Program for  member districts and many non-member school districts. Since the Collaborative began providing this service in 1994, more than $25 million have been returned to the participating cities and towns.

NRC coordinates reimbursement with University of Mass Medical School (UMMS) using a centralized on-line system. We obtain the necessary information from school districts and interpret the results in order to complete and submit claims, minimizing district staff workload.

NRC currently serves 18 school districts through NRC’s dedicated School Based Medicaid staff in the Business Services Division.

How Can NRC Help You?

If you are not utilizing School Based Medicaid reimbursement, you are losing out on valuable dollars. Statistics from the Massachusetts Department of Elementary and Secondary Education and MassHealth show that the statewide average of Medicaid eligible students is 17% of the special education population.

Gathering the information necessary for Medicaid reimbursement is a tedious process that local school districts or town governments do not have the resources available to perform. North River Collaborative offers a comprehensive solution.

North River Collaborative will:

  • Coordinate enrollment agreements
  • Identify eligible students
  • Help obtain parental permission
  • Enter attendance data
  • Reconcile paid and unpaid claims
  • Submit electronic claims
  • Verify amounts paid to towns
  • Train and work closely with your staff
  • Ensure program compliance
Our knowledgeable School Based Medicaid staff keeps you up-to-date on all regulatory changes, updates, and compliance issues.
The benefits of using North River Collaborative as a billing agency are:
  • Expertise working in school districts
  • Knowledgeable in the School Based Medicaid Program
  • Familiarity with the MassHealth claims processing and MA-DESE regulations
  • Support during audits and compliance reviews
  • Coordination of the reimbursement directly to the town or school district through our web based document service
  • Ability to bill after the town receives payment

Forms and General Information

FAQ-Random Moment Time Study

Helpful Tips for a Successful RMTS

Medicaid Billing Form

Medicaid Brochure