The schools can be the best institutions to offer Medicaid programs to children. A joint state-federal program, Medicaid programs cover the administrative activities cost and medical services while reimbursing them.

Schools deliver a range of services that can help students learn in the school while staying healthy and availing the instructional services. As per the Rehabilitation Act of 1793 section 504 and IDEA (Individuals with Disabilities Education Act), schools provide a spectrum of needs that also include medical services. These lie under the Medicaid program.

#1 Knowing the Services

IDEA-related health services: According to IDEA, children with disabilities can have free appropriate special education to meet their requirements.

Section 504-related health services: Following this rule, the local school districts should pay for or provide certain benefits for the disabled to receive a good education.

General health care services: These services are important as they include a scoliosis exam, hearing tests, vision exams, health care screenings, etc., without any charges.

School-based Medicaid Billing

#2 Selecting the Medical Billing Company

You have to be very careful in selecting a billing companies for school-based medicaid billing. Ensure if the vendor can integrate with the school’s record system. This can help to streamline the processes while accessing the documentation. It should also help to develop an information management system to track the billable hours. 

Further, the vendor must review the documentation and check for the specific service data elements. 

#3 Getting Software Setup

To reimburse the Medicaid claims, each school district must know their needs and requirements. They should understand what works best for them. You can ask for RMTS (Random Moment Time Study) monitoring to help identify the status of the form anytime, anywhere. Sometimes, it also assists you with interim (quarterly) billing. This ensures a seamless audit and appropriate reimbursement. 

The school-based medicaid billing software must precisely integrate with the special education software that can help in claims submission. It should also assist in claims reconciliation and validation, offering a complete data analysis. 

This may incur additional costs to submit the claims electronically on behalf of the district. This amount will depend upon the nature of the software, training needs, cost, and staff capacity.

School-based Medicaid Billing

#4 Securing Compliant Documentation

Securing the compliant documentation is a critical step. Under this, you should ask the vendor to document the service covered for each student. While it is a tedious process, it is a vital part of compliance. Moreover, it will save the municipality and your school during any audit trials.

In addition, ensure that each of the compliant document includes the following details:

  • Student name
  • Student date of birth
  • School provider number/district name
  • Medicaid number of the student
  • Individual/Group activity performed
  • Date of service
  • Time of service
  • Signatures

#5 Preparing Staff Workflows

The school-based medicaid billing service provider shall train your staff with the needed training. While the processes seem simple, there should not be any missing documents or wrongly claimed files. Most billing companies train every new school, as well as hosting quarterly or yearly sessions. 


To make your school-based medicaid billing process smooth and quick, the best decision is to go for the best medical billing company. It will help you with the advanced software and produce optimized staff workflows. Thus, the FERPA and HIPAA-compliant service provider, NEMB, can offer some administrative relief with their technology system. Get in touch today to know more about the facilities.


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