Classic Path: System Administration > Medicaid
Search Terms: Medicaid
The Medicaid tools available in System Administration provides users with the ability to configure Medicaid services, service providers, Insurance types and other settings related to the maintenance of Medicaid information for students.
See the Tool Rights article for descriptions of tool rights for this area.
Medicaid Terminology and Acronyms
Term | Definition |
|---|---|
GC | Group Code |
HIPAA | The Federal Health Insurance Portability and Accountability Act |
ID | Identifier |
NPI | National Provider Identifier |
TIN | Tax Identification Number (SSN, EIN, ITIN) |
Qualification for Medicaid Billing
In order for a school corporation to be able to bill for Medicaid-covered IEP services using the school's Medicaid provider number (NPI), the following requirements must be met:
- The student must be enrolled in the state Medicaid Program.
- The student must qualify for special services under IDEA.
- The student must have an IEP developed under the IDEA authority.
- The Medicaid eligible services must be specified in the IEP.
- The services must be rendered by a provider who meets Medicaid qualifications and who is qualified to provide the service under applicable state licensure or certification requirements.
- The school corporation must obtain a signed release/consent form from the parent(s) in order to verify the student's eligibility for Medicaid and to bill Medicaid for covered IEP health related services that are provided to the student.
- The school corporation must bill other liable insurers first before billing Medicaid for these services.
Medicaid Claims
There are two types of claiming - Administrative and Services.
Administrative Claiming
The Medicaid program uses federal funds to reimburse administrative activities necessary for the proper and efficient administration of a state Medicaid plan. The Medicaid School Based Administrative Claiming (SBAC) program reimburses school districts for the time employees spend in administrative activities that directly support efforts to identify and enroll potential eligible children and their families into Medicaid. SBAC involves all school district staff who, as part of their routine job duties, help students to community medical and mental health providers or collaborate with other school staff or community agencies to better address the health care needs of students.
Services Claiming
The Medicaid SBHS program is designed specifically to allow school districts to act as health care providers and be reimbursed under Medicaid. School districts may be reimbursed approximately 70 percent of the state and local funds they spend on some related services in the individual education programs (IEP) of children with disabilities who are eligible under both IDEA and Medicaid.
At this time, Infinite Campus is only supporting SBHS claims.
