Accelify Client Success
October 20, 2014
THE CLIENT: Agency that sets policies, provides resources (including transportation services), and exercises accountability for public schools in the State.
THE PROJECT: Fee-for-Service Transportation Medicaid Billing
Our client provides transportation services for students in the state, including the special education population. Transportation services are only eligible for reimbursement when they are provided to students who receive direct health services on the same day – and those services have been reimbursed. Because our client manages the transportation services for all students in the State and the School District provides and claims the reimbursement for direct health services to its students, our client faced challenges with integrating the required data from both parties and navigating privacy regulations on data sharing. Due to these challenges, they had not been claiming transportation services at all prior to engaging Accelify, and was losing this significant reimbursement opportunity every year.
Accelify worked closely with our client’s program and policy staff, transportation staff, IT database specialist’s and support staff to facilitate internal meetings discussing the proper documentation of transportation services, access to IEP data authorizing services, and privacy policies and concerns.
In addition, Accelify facilitated discussions between our client and the School District to establish data sharing agreements concerning health services provided to students, parental consent information, and other necessary data points to ensure the proper validations are run prior to the claim being submitted for Medicaid reimbursement.
Accelify also consulted with and participated in meetings with the State Medicaid Agency and their appointed claiming oversight organization to establish a methodology to develop the claims to ensure audit compliance. Accelify participates in bi-weekly meetings with all parties involved where we provide guidance concerning policy interpretation, and technical assistance on the proper file structure and formatting of claim and eligibility files. In addition, Accelify has assisted our client with establishing a claiming methodology for transportation services provided to charter school students in order for them to begin claiming Medicaid reimbursements for those services.
In addition to the programmatic issues outlined above, Accelify also had to provide a technical solution to import data from multiple systems to claim validated transportation services. In order to implement transportation claiming, Accelify developed a customized version of AcceliROUTE, a comprehensive transportation management and claiming tool. For our client, AcceliROUTE was set up to import ridership data, IEP authorization data, and student data from various sources and systems including the Student Information System (SIS), Individual Education Plan system (IEP) and paper transportation ridership logs.
Using these dissimilar data sources, AcceliROUTE compiles a file of eligible transportation services and then interfaces with AcceliCLAIM to crosswalk this file against paid claim data from the School District to identify which transportation services were provided on the same day that direct services were provided and claimed. Following that, additional validations are run against different data sets to ensure:
- That the provider that provided the service had the proper license or credentials on the date the reimbursable health service was provided.
- That the student that was transported had transportation services authorized in their IEP on the date the transportation was provided.
- That the student had a valid parental consent to bill Medicaid on the date the transportation was provided.
- That the student was Medicaid eligible on the date the transportation was provided.
The validated transportation services are then built into X-12 format and processed for Medicaid claiming. The robust validation processes occur before transportation claim submission to ensure a high paid claim ratio, low denial rates, and eliminate burdensome administrative work for staff while maximizing reimbursement available.
Accelify then performs a denial assessment on each claim. This provides our client with insight as to why claims are being denied, and if applicable, provides a corrective action plan to correct and resubmit incorrect denials. Our client has had multiple issues with claims being denied improperly during its claiming cycles. In these cases, Accelify has been able to provide data and analysis to to show the validity of the claims that have resulted in transportation services being resubmitted and approved for reimbursement.
Since implementing AcceliROUTE, our client successfully back-billed for transportation services from 2010/11 SY as a result of Accelify’s analysis of prior claims and identification of additional services that could be claimed. In the last fiscal year, our client received over 2 million in reimbursements for transportation services.
In addition, due to the successful implementation of AcceliROUTE, and the amount of reimbursement in Medicaid reimbursement generated, our client has now started several other initiatives in conjunction with Accelify including:
- Claiming for health services provided to non-public school districts
- Claiming for health services provided in charter schools
- Claiming for services provided to Early intervention (EI) students
These additional programs are projected to bring our client millions of dollars more in Medicaid reimbursement.