Municpal Medicaid Reimbursement
Introduction
North River Collaborative (NRC) is a billing agent for MassHealth’s School Based Medicaid Program. This program reimburses school districts that provide health-related services to students who are Medicaid-eligible. The primary component for reimbursement is having Medicaid-eligible students with parental consent.
The School-Based Medicaid Program consists of three components:
- Direct Services
- Administrative Activities Claims
- Annual Cost Reporting
Direct Service Claiming reimburses school districts for providing health-related services to eligible MassHealth students pursuant to an eligible IEP. NRC utilizes online documentation and reporting to prepare and submit monthly claims.
Administrative Activities Claiming is reported each quarter and includes information regarding direct support staff and administrative personnel to the special education department. Quarterly salaries, fringe benefits, transportation and tuitions are required from each district to complete these reports. This information is entered into the School Based Claiming formulated templates, uploaded and approved.
History
Annual Cost Reports may provide additional Municipal Medicaid Reimbursements in reconciliation of Direct Service and Administrative claims. The Cost Report is a check and balance of the previous fiscal year payments.
NRC implemented Direct Service reimbursement for cities and towns in 1993. NRC coordinates the School-Based Medicaid Program for our member districts and many non-member school districts. Since the Collaborative began providing this service, millions have been reimbursed to the participating cities and towns.
NRC processes reimbursement with University of Mass Medical School (UMMS) using a centralized on-line system. NRC’s dedicated staff currently provides the School-Based Medicaid program to numerous school districts.
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 the statewide average of Medicaid eligible students is 17% of the special education population.
Gathering information necessary for Medicaid reimbursement is a time-consuming process that local school districts do not have the resources to perform. North River Collaborative offers a comprehensive solution.
NRC will:
- Coordinate State agreements
- Identify eligible students
- Help obtain parental permission
- 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 your billing agent:
- Expertise working with school districts
- Knowledgeable of the School-Based Medicaid Program
- Familiar with processing MassHealth claims
- Support during audits and compliance reviews
- Funds are dispersed directly to the town or school district
- NRC invoices districts after the town receives payment
- One specialist is assigned to your district
- Online documentation and reporting