The purpose of this article is to outline the Medicaid Documentation Request and Upload Process.
The required documentation would include:
- INDIVIDUAL EDUCATION PLAN (IEP)
- PRESCRIPTION (Orders, Referrals, Recommendations)
- PARENTAL CONSENT FORM
- All of these documents are required in order to submit a claim to Medicaid.
[Any requests for Medicaid documentation will not include the child's name; instead the child will be defined by the enrollment ESID #. Listed below are instructions for looking up a child by an ESID # in the Portal.]
INDIVIDUAL EDUCATION PLAN (IEP) - An IEP must be uploaded under the following circumstances:
- Following an Annual Review Meeting
- Following a Program Review Meeting (if the frequency, duration or class size changes)
- Following an New Referral Meeting (if the child is identified)
- Following a Re-Evaluation Meeting
- If a child is receiving Medicaid related services for the summer and winter sessions, there must be an IEP uploaded for each session unless both the summer and winter services are listed on the initial IEP for the school year.
To check whether you are missing IEPs, you can use the Missing IEPs Report or the Missing Documents Preventing Claiming Report
Missing IEP Report:
This report will give you a list of children for whom an IEP (or a component of an IEP) is missing. IEPs are not verified as an all-inclusive document. Why? There may be several services listed on a child's IEP (OT/PT/SP) - one (or more) of these services may be okay to verify (because the Portal enrollment matches the IEP mandate); however, there may be one (or more) services that cannot be verified for any of the reasons listed below:
- The frequency, duration or class size in the Portal does not match the IEP mandate
- The dates in the Portal do not match the service dates on the IEP
- The document may have been scanned badly causing the entire document to be unreadable (for all services), or,
- An IEP was uploaded, but it was for the wrong child.
In the example below all the services listed on the IEP could not be verified.
- The IEP delineates OT as 2x30 Individual, but is entered into the Portal as 3x30 Individual. At this point we are looking for another IEP that shows the 3x30 Individual frequency/duration or if the IEP is correct, we need the enrollment to be corrected by the school district or county.
- When this (OT 3x30 Individual) enrollment is assigned to an uploaded IEP, this specific ESID # will no longer appear on the "Missing IEPs" Report.
- The other service listed on the IEP (Speech) can be verified because the Portal enrollment matches the IEP mandate.
IEPs will also show as "missing" when the IEP service dates differ from the Portal enrollment dates (e.g., IEP Dates 9/4/18 to 6/25/19 - Portal Enrollment Dates 9/1/18 to 6/28/19) This cannot be verified because there is a chance of Medicaid being billed for attendances that fall outside of the service dates shown on the IEP. If any service line on the IEP cannot be verified to the Portal Enrollment, the IEP will maintain a status of "missing"
The Missing Documents Preventing Claiming Report (Medicaid>Missing Documents>Missing Documents Preventing Claiming) will list the specific service, dates and mandate for the IEPs that are missing (see screenshot below). If an IEP is "Missing", it will show under the Need IEP column to the far right.
How to Upload an IEP:
- Go to Medicaid>IEP Maintenance
- Type in the name of the child and click "Search"
- Click "Select" next to the appropriate child if multiple options populate
- Select the School Year from the drop-down menu
- Click "Choose File" and search for the document on your computer
- Enter the Effective Date (start date of the service)
- Click "Upload IEP"
Requests for Outstanding IEPs: As previously mentioned, in order to verify a Portal enrollment to a child's IEP, the dates of the enrollment, the frequency, duration and class size must match the IEP (exactly) for each therapy/service delineated on the IEP. If any service delineated on the IEP cannot be verified to the Portal enrollment, the IEP will remain as "missing" and you may receive requests to upload an IEP that matches the enrollment criteria.
If you receive a request for an outstanding IEP, please obtain the IEP document and upload it to the Portal at your earliest convenience. If the enrollment was entered incorrectly and an IEP does not exist for the requested service/frequency/duration/class size, please reply with that information.
PRESCRIPTION (Orders, Referrals, Recommendations)
In order to bill Medicaid, a prescription from a qualified Medicaid provider is required. Prescriptions must be "prospective" and must be kept on file.
A prescription should be uploaded under the following circumstances:
- For each IEP period (Annual Review, Summer/Winter Session if not listed on the same IEP)
- Whenever a review meeting results in a change of service (frequency/duration/class size)
- The child transfers to another school district (This requires a new IEP to be generated so a new order is required.)
- New Referrals (Newly-identified students)
- Annual Review Meeting * Change in Service * Transfer Meeting * New Referral
To check the status of prescriptions for your agency, you can use the "Missing Scripts" report which will show you a list of Missing Prescriptions and Verified or Un-Verified Prescriptions.
Missing Scripts Report:
- Go to Medicaid>Missing Documents>Missing Scripts
- Filter for Session and County
- Filter for Missing Scripts, Not Verified Scripts and/or Verified Scripts
- Click "Retrieve"
How to Upload a Prescription:
Listed below is a tutorial from the Portal Knowledge Base that will walk you through the upload process. This article also includes troubleshooting tips.
How to Complete a Digital Speech Recommendation:
Listed below is a tutorial from the Portal Knowledge Base that will walk you through this process.
Requests for Outstanding Prescriptions:
Periodically you may receive a request for "missing" prescriptions. The Missing Scripts Report and/or the Missing Documents Preventing Claiming Report will show you the From Date, To Date, Service, Frequency, Duration, Class Size and ESID # for the enrollment that requires a prescription. You may want to check the child's Written Orders Tab (Lookup>Child Lookup>Written Orders Tab) to see if the prescription is missing or if it has been invalidated. Once an uploaded prescription is invalidated by McGuinness, the status of the prescription reverts back to "missing." If the prescription has been invalidated, you will receive an email from McGuinness detailing why the prescription did not meet Medicaid requirements and a request for a replacement prescription.
If you receive a request for an outstanding prescription, please upload it to the Portal at your earliest convenience.
Listed below are some other helpful tutorials regarding Medicaid documentation and Medicaid compliance as it relates to prescriptions.
Medicaid Policy & Billing Handbook (Update 10) - What is required on a Medicaid Prescription - Pages 21-22
PARENTAL CONSENT FORM
Parental Consent forms do not need to be uploaded annually. However, a signed Parental Consent Form should be uploaded for each child receiving Medicaid related services.
Missing Parental Consent Report:
To check whether you are missing a Parental Consent Form, use the Missing Parental Consent Form Report. You can also use this report to upload parental consents.
- Go to Medicaid>Missing Documents>Missing Parental Consent
- Select the school year>Select the county
- Filter for the following: Missing consents, Failed to Obtain, Waiting to be Verified or Verified
- Click "Retrieve"
- If you have the Medicaid Parental Consent for a child on the list, you can click the "Upload Consent" link to the far right of the child's row
- Click "Choose File" and select the document on your computer
- Enter the "Date Parent Signed" and "Reported CIN" (if listed on consent)
- You can choose from the drop-down menu on the right if the parent "Consented" or "Refused"
- Click "Upload"
How to Upload a Parental Consent Form using Parental Consent Entry:
- Go to Medicaid>Parental Consent Entry
- Enter the name of the child
- Click SELECT on the left
- Click "Choose File" and select the appropriate file from your computer
- Type in the "Date Parent Signed" and "Reported CIN" (if listed on consent)
- Choose "Consented" or "Refused" from the drop down
- Click "Upload"
Requests for Outstanding Parental Consent Forms:
Periodically you may receive a request for a child for whom we have the other documentation to submit a Medicaid claim but the Parental Consent Form is outstanding. If you receive this type of request, please obtain the outstanding documentation and upload it to the Portal at your earliest convenience.
If you have any questions regarding Medicaid documentation or compliance, please contact the Medicaid Support Team at
medicaid@cpseportal.com or the Medicaid Specialist
Deborah Frank at: Phone - 518-393-3635, Ext. 41 / Email - dfrank@jmcguinness.com