Overview
CESA 9 contracts with third-party claiming agencies to maximize claim return to individual districts utilizing large pool purchasing leverage, minimizing local district administrative and clerical involvement, and reducing denied claims.
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Teri Phalin
Executive Director of Special Education & Student Services
Email
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Description
LEAs may submit claims to Wisconsin Medicaid (Forward Health) for covered School-Based Services (SBS) provided to Medicaid-eligible students enrolled in special education programs with eligible services listed in their Individualized Education Program (IEP). These services include speech, occupational and physical therapy, nursing, attendant care, and transportation.
Third-party claiming services include, but are not limited to:
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Liaison with Wisconsin Medicaid for program guidelines, policies, and procedures
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Medicaid eligibility and billing for services
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Consultation, education, and training (including user manuals, video tutorials, large group, and individual sessions)
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Monitoring and reporting of reimbursement volumes and trends
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Service documentation and storage
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Medicaid resources and direct user support for providers, administrators, and support staff
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The investigation, rework, and reprocessing of denied claims
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Support during audits and with annual cost reporting
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Continuous improvement for best practice
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Executive presentations and custom reporting to maximize the claim cycle
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Medicaid revalidation
Claiming Agency options:
Kyles Consulting, LLC
Cost: $4.00 per special education student per month
MJ Care, Inc.
Cost: $4.75 per claim
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