Medicaid Documentation

Medicaid Documentation
 
 
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, use the Missing IEPs 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 scanned badly causing the entire document to be unreadable (for all services), or,
  • An IEP was uploaded, but it was for the wrong child.  
If any service line on the IEP cannot be verified to the Portal Enrollment, the IEP will maintain a status of "missing" and the "Missing Documents Preventing Claiming" Report" (Medicaid>Missing Documents>Missing Documents Preventing Claiming) will list the specific service, dates and mandate that cannot be verified (see screenshot below)
 
In the example below all the services listed on the IEP could not be verified. 
  • The IEP delineates OT as 2x30I, but is entered into the Portal as 3x30IAt this point we are looking for another IEP that shows the 3x30I frequency/duration
  • When this (3x30I) 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. 
 
 
Missing IEP Report: 
How to Upload an 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 will continue to 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
  • The "As per IEP" reference does not apply once the IEP changes.  A new prescription is required for any of the circumstances listed above.  
Under certain circumstances we are permitted to include "supplemental" information for Medicaid prescriptions.  If a prescription was uploaded and subsequently "invalidated" for any of the following reasons...
  • Incorrect Date of Birth
  • Missing Term of Service
  • Missing NPI/License #
  • Missing Contact Information (complete address & phone) for the practitioner
you can re-upload the previously-invalidated prescription along with a completed Supplemental Prescription Information Form (creating a two-page scan).  The Supplemental Prescription Information Form should only delineate the excluded information that caused the prescription to be deemed invalid.  The original prescription must not be altered.
 
Please Note:  To upload the supplemental information, you must upload a two-page scan (the previously-invalidated prescription and the Supplemental Prescription Information Form).  You must also re-enter the prescription details and attach the scanned two-page image as if it was never entered previously.   
  • Scan the two-page document to your computer.
  • Complete the Manage Prescription Entry Screen and select the enrollment(s) that the prescription covers
  • Complete the Manage Prescription File Screen, upload the prescription images and select the Potential Eligible Order(s) 
Listed below is a link to the Supplemental Prescription Information Form: 
 
Missing Scripts Report:
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 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 deemed invalid, the status of the prescription reverts back to "missing."  If the prescription has been invalidated for any of the reasons stated above, you can re-upload it along with the Supplemental Information Form and your prescription can be verified for claiming.  
 
 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 9) - 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.  
How to Upload a Parental Consent Form:  
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 Deborah Frank at:  Phone - 518-393-3635, Ext. 41 / Email - dfrank@jmcguinness.com.