Medicaid Claiming Service

Service Description

Questar III’s Medicaid Claiming Service is designed to help school districts realize and claim all available Medicaid reimbursements. In addition, we will help answer compliance questions and support your completion of the Medicaid Cost Report. We are currently offering the service to clients who claim through Frontline.

With our different levels of service, you have the flexibility to tailor your experience. You may require assistance with training and compliance, claim submissions, or reviews. You might prefer a comprehensive service that includes Questar III BOCES overseeing and managing the submission of the entire Medicaid Claiming process, starting with the entry of prescriptions. This customizable approach ensures that our services align with your specific district needs.

No matter what Level of Service you choose, Questar will always have your district’s best interest at the forefront, ensuring you are in compliance and maximizing returns.

Level I: Best Practices Review

• Review your current claiming procedures and practices
• Complete a brief review of current claims and rejections
• Provide training and tips for Frontline
• Provide feedback to help improve systems and potentially increase claims
• Assist you with current rules and regulations for claiming
• Help to create systems for your district for smooth claiming
• Provide written observations and recommendations of completed review

Level II: Medicaid Claiming

• Review eligibility files and alert district of the need for the One-time Parental Consents for potentially eligible students
• Import services into Frontline Medicaid from the RS Log in Frontline IEP, validate requirements and accept or reject services
• Submit claims entered by district in Frontline
• Review all rejected claims, obtain necessary information to resubmit claims, and provide feedback if errors are recurring
• Record and submit paper copies of claims from outside agencies not using the RS Log
• Obtain and submit Transportation Logs for students receiving special transportation
• Obtain and submit Medication Administration Records (MARS) from Health Services
• Monthly Review of the Exclusion List to ensure all providers are valid
• Assist with state compliance and reporting
• Support your completion of the Medicaid Cost Report

Additional For Fee Option:

Questar will complete basic office data entry, including:

• Maintain users in Frontline IEP and update as needed to include: NPI number, credentials, license information, USO/UDO designation, electronic signature
• Enter and maintain Medical Personnel who sign Orders and Referrals including NPI numbers and license information
• Enter and Link orders and referrals to services and evaluations
• Assist in Obtaining One-Time Consent for Services

Experienced and Knowledgeable Team

This COSER is a new offering from Questar III BOCES and is currently staffed by Angela Beber. Angela also works as a STAC Analyst for Questar’s Special Education Aid Assistance Service. She brings 15 years of experience working in Special Education office administration. She has experience and extensive knowledge in reading and understanding IEPs, submitting Medicaid claims, completing Special Education forms and reports (i.e., IDEA Grants, MOE Calculator, Medicaid Cost Report), and managing STACs.