The Massachusetts Medicaid claiming process can be confusing, especially if you are not familiar with the applicable regulations and Medicaid billing process. Navigating through the school-based Medicaid system can seem daunting, but it doesn’t have to be so complicated and time-consuming when you work with a team of experts.

This complete guide will walk you through the ins and outs of Medicaid claiming and help you cut down on some of the extra red tape that comes with submitting claims with the state of Massachusetts. You’ll also find helpful resources on our website, including an insurance glossary as well as answers to some of the most commonly asked questions about the school-based Medicaid program in Massachusetts.

Section 1: What is the School-Based Medicaid Program?

The School-Based Medicaid Program allows LEAs (Local Education Agencies) to acquire government funds to help mitigate the expenses of offering Medicaid-covered specific services in schools. 

Furthermore, the school setting offers a unique chance for localities to collaborate and register eligible kids in MassHealth. Plus, it offers assistance to those who are already enlisted for obtaining the necessary benefits.

Section 2: School-Based Medicaid Program Latest Information

The school-Based Medicaid Program focuses on offering foundational information along with PowerPoints and training videos. The SBMP 101 Training includes the roles and responsibilities of each LEA. A few of the module objectives include training to roles of Direct Service Providers, Technology Leadership, Financial Leadership, RMTS Coordinators, Administrators, Clinical Leadership, etc.

Section 3: School-Based Medicaid Training from NEMB

With School-Based Medicaid Training from NEMB, you will receive training with respect to RMTS, Cost Reports and the Quarterly Administrative Claim.

There are three separate possibilities that you may pick from for the reimbursement process. The school-based medicaid claiming programs offer information and methodologies about the fee-for-service billing. While the claims are processed on a quarterly basis, it involves different professional activities such as PTO, direct therapy time and educational services. So, to ensure that the sampling to the RMTS does not encompass any errors and has a seamless operation, the training lists a detailed plan. 

Further, the Cost Reports Training will include the Cost Share Supplemental Detail Report, OOD Tuition Program List, and Step by Step Manual SBMP Cost Report. In addition, the Quarterly Administrative Claim shall include its Step by Step Activity Claiming Process, with Medicaid Eligibility Matching, AAC Claim Preparer training and much more.

guide to school-based medicaid

Section 4: School-Based Medicaid Resources

After enrolling as a school-based medicaid program provider, the Local Education Agencies can initiate the contracting process by getting in touch with our team. 

The Medicaid Program of Random Moment Time Study and Administrative Activity Quarterly Claims begin on July 1, 2021 for Quarter 1.

A few things that you should know about the 2020-2021 school year – 

  1. You did not make a formal diagnosis if you have used Diagnosis Codes
  2. A qualified practitioner demonstrates documentation as Authorization. You can call it a Treatment Plan or Plan of Care.
  3. It is true to note that the “billing form” is not Service Documentation. Service Documentation involves the treatment notes of clinical service delivery made by the practitioner. 

Section 5: How Can NEMB Help Your School?

NEMB helps with all aspects of the School-based Medicaid claims. For instance, we can ensure you to support you by:

Providing relief from administrative responsibilities: 

NEMB eases the administrative load of monitoring IEPs off your shoulders with its technology and devoted employees. Eligibility inspections, data tracking, and handling dismissed claims are what NEMB takes care of for your school. 

Conducting random moments surveys: 

It can be harder to fulfill your state’s criteria. With us, you can be confident that you will be able to meet RMTS Compliance Obligations in your area. Moreover, NEMB provides daily reminders to employees to address questions via the technology platforms. 

Thus, it makes it easy to respond to a query and continue their day immediately. Furthermore, we keep track of your district’s contributions and can provide you with an update on a real-time basis.


NEMB simplifies every process of school-based Medicaid invoicing. While retaining HIPAA and FERPA adherence, the simple procedure of NEMB relieves your employees of administrative burdens and results in high returns.


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