Medicaid Information & Resources - Special Education Finance & Medicaid




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Programs & Services : Special Education Finance & Medicaid : Medicaid Information & Resources


PROGRAMS & SERVICES: SPECIAL EDUCATION FINANCE & MEDICAID: MEDICAID INFORMATION & RESOURCES (Updated 2/4/13)

The Medicaid School Based Health Services Program is used by the State to generate Medicaid reimbursement for medically related services provided in accordance with an Individual Education Plan (IEP). Schools bill Medicaid directly for services and receive a monthly grant award from the Agency of Education based on the claims submission to Medicaid. The information in this section includes resources, required documentation and manuals to assist school staff in the accurate submission of Medicaid claims.

MEDICAID INFORMATION & RESOURCES

	Manual for School-based Health Services (Medicaid Manual) PDF This document is a compilations of information about the School-Based Health Services program. The manual provides information on all aspects of the program, from the state statute that allows schools to bill Medicaid, to instructions and requirements for Medicaid forms and paperwork.

	Medicaid Forms The following documents are the current forms for the School-Based Health Services Program: Case Management Assurance Form WORD Developmental & Assistive Therapy Log WORD Evaluation Claim Form EXCEL IEP Claim FormEXCEL Level of Care (LOC) Billing FormEXCEL Out-of District Provider Certification Agreement PDF Personal Care Log WORD Personal Care Verification Form EXCEL Physician Authorization Form PDF PNMI Claim Form EXCEL Provider Certification Agreement PDF Related Services Log WORD Release of Information Form WORD Release of Information Form - 18 Year Old Student WORD Release of Information Form - Blanket ReleasePDF

	Medicaid Resources The following documents are resources designed to assist the Medicaid clerk in the accurate completion and submission of Medicaid claims: Clerk List PDF Developmental and Assistive Therapy - Five Questions PDF Diagnostic Codes PDF Documentation Log Changes PDF Documentation Log Tips for Providers PDF Six Month Deadline Chart PDF Level of Care (LOC) Flow Chart PDF Level of Care (LOC) Rate Sheet PDF Parent Brochure PDF Provider TypePDF Recipient Aid Categories PDF School District Codes PDF

CONTACT INFORMATION

	Special Education School-based Health Services & Medicaid Nicole Tousignant, Medicaid Program Coordinator (802) 828-5111 (P) (802) 828-1631 (F) nicole.tousignant@state.vt.us



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