EDMS’s School Medicaid Administration System empowers administrators to effectively manage their responsibility to submit compliant claims for Special Education students who are enrolled with Medicaid.
Medicaid Claiming Services
EDMS delivers complete School Medicaid Claiming services including:
- Submission of Medicaid claims via electronic batch to Medicaid fiscal agent
- Tracking of submitted claims
- Research and resubmission of suspended or denied claims
- Reconciliation of remittances, both paper and electronic
- Review and authentication of documentation used in the claiming process
- Administrative assistance to district administrative staff and service providers
- Medicaid eligibility verification and updates
EDMS is experienced in the following billing/data collection programs:
- Direct Service Claiming
- Fee-for-Service Claiming
- Interim Claiming
- Random Moment Time Studies
- Cost-Based Claiming
- End-of-Year Cost Reconciliation
Lumea™ Service Documentation
EDMS’s Lumea service documentation system provides Medicaid administrators and service providers with a secure, standardized system for collecting service delivery data required by Medicaid policy. Some of Lumea’s time-saving features include:
- Calendar-based system for scheduling one-time and recurring appointments
- Ability to easily add or remove students from pre-scheduled appointments
- Calculates units of time automatically based on established guidelines
- Calculates group sizes automatically for cost allocation purposes
- Administrative tools to manage users, user permissions, caseload assignments and non-school days
- Reporting that allows administrators and service providers to monitor documented services and levels of service provider participation
- Confirms that minimum data requirements are included (i.e. date, time spent, students involved, services delivered, narrative, goal progress, electronic signatures, etc., when applicable per state guidelines)
- Technical assistance (toll free) for all Lumea users via phone, live chat and email
- Reporting options to track student progress
- Seamless integration with Adori™ IEP management module and Acuity™ 504 management module
EDMS is not only committed to helping school districts maximize their Medicaid reimbursements, but also to providing regulatory consultation and technical assistance so districts can better weather audits by:
- Providing program assistance via dedicated Program Specialist assigned to each district
- Publishing forms, regulatory correspondence, checklists and other helpful information on our website
- Inviting districts’ participation at multiple informational and professional development venues including webinars, forums, workshops, in-district trainings, etc.
EDMS’s audit support includes:
- Assistance with gathering and cataloging information to support Medicaid claiming
- Coordinating schedules and timelines with auditors
- Facilitating correspondence between the district and the auditors when additional information or follow up is needed
- Applying extensive experience to recommend responses when audit findings are received
- Recommending processes to reduce future audit findings
Provider Exclusions Matching
EDMS assists school districts with identifying those service providers, administrators and other staff who may be included on either the Office of Inspector General’s List of Excluded Individuals and Entities (LEIE) or the federal government’s Excluded Parties List System (EPLS).
EDMS submits information provided by the school district on a monthly basis, and provides the district with information that may require action by the district regarding excluded individuals participating in the school Medicaid process.
To learn more about LEIE and EPLS click here.
School Medicaid Consulting
While we provide Medicaid claiming services for public schools, we can also offer our consulting services with or without actually processing claims on behalf of the school district. Click here to learn more.