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Direct Service Claiming (DSC)

  • Provider eligibility.  NEMB verifies staff therapy providers’ licensure in accordance with Medicaid requirements.
  • Student eligibility.  NEMB validates students’ special education enrollment, eligibility to receive Medicaid, and written parental consent to bill. We assist schools in obtaining written consent through direct mailing efforts and education of providers, who may then inform parents directly about Medicaid requirements and benefits.
  • Provider Service Documentation. NEMB reviews all school staff therapists’ service documentation to confirm all required and relevant service data components are present. Moreover, daily monitoring, a schedule of emailed (or even telephone) reminders to specifically targeted therapy providers and administrators ensures maximum compliance with Random Moment Time Study requirements; guaranteeing maximum allowable reimbursements.
  • Quarterly (interim) billing.  NEMB methodology delivers comprehensive and accurate billing for all qualified services provided by the school.
  • Direct Service Cost Reporting. Annual costs reports include data related to purchase services, medical supplies and materials, and therapy provider salaries. Time-tested systems of financial data gathering and auditing provide accurate and detailed reports, resulting in maximum cost reporting; maximum reimbursements.

Administrative Activity Claiming (AAC)

  • Administrative Cost reporting. Quarterly reports include all administrative costs related to internal special education programs, as well as Out of District school programs. This can include transportation to and from school, personnel salaries and benefits, Medicaid approved general supplies and materials, applicable overhead expenses, and tuition costs.
  • Medicaid eligibility enrollment reports. These reports detail the number of students who are eligible for Medicaid in a particular school as well as which students are enrolled in special education programs.
  • Random Moment Time Study (RMTS) monitoring. Therapists and all Direct support personnel are included in the random moment time study. Daily monitoring and outreach to participants significantly augments compliance.
  • RMTS quarterly updates. The RMTS spreadsheets are updated and verified for compliance quarterly.
  • Ensure that all deadlines are met. NEMB ensures the liaisons in the school districts are kept to program deadlines (required by the state) so not to forfeit any reimbursement.
  • Continual training. NEMB continually keeps abreast of all state and federal changes made to the School Based Medicaid Claiming program, and guides appropriate School personnel, as necessary.
  • Training new personnel. Personnel changes within the school during or at the beginning of any fiscal year may require training, and is included.
  • Data Analysis. NEMB meets with Superintendents, School Boards and other stake holders to provide pertinent School Based Claiming information.
  • Calendar updates. The state requires updates to their web based calendar system annually and throughout the year. This requirement is fulfilled by NEMB’s assistance for all client schools.
  • Security. NEMB is compliant with HIPAA and FERPA regulations..
  • Superior Customer Service. Every client has a single contact with same-day response.

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