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Medical Billing Clearinghouse

Healthmaster has its own HIPAA compliant clearinghouse where it submits Medicaid claims directly to the state Medicaid agency. All of your claims are handled securely by Healthmaster.

Periodically, generally on a weekly basis, the data needed to determine Medicaid eligibility and to submit claims is automatically accumulated and batched by the district’s Medicaid coordinator from the data in the HealthOffice Anywhere database and is sent to Healthmaster’s in-house HIPAA-compliant Claims And Remittance Entry (CARE) system. With our Medical Billing Clearinghouse all of the costly, labor-intensive work of having the healthcare professional document twice (once for the student file and once to send to the Medicaid department or enter into an on-line system), the Medicaid department staff data-entering the information and the preparation of claims is completely eliminated.

From our secure facility, we electronically generate and process HIPAA-compliant transactions for Medicaid Eligibility Determination (HIPAA 270 – Eligibility Requests), record state-determined eligibility (HIPAA 271 – Eligibility Response), prepare and file the applicable claims (HIPAA 837 – Medicaid Claims Submission) and record and reconcile the district’s remittance from the state Medicaid agency (HIPAA 835 – Medicaid Payment Remittance Advice). The check from the state Medicaid agency is sent directly to the school district.

Healthmaster's Medical Billing Clearinghouse submits Medicaid eligibility requests electronically utilizing HIPAA 270 eligibility request procedures identifying student medicaid IDs, if known, or requesting eligibility information utilizing first name, last name, and date of birth (3-point match basis) for all students in the district on a monthly basis. When eligibility information is returned to Healthmaster in an electronic HIPAA 271 eligibility response, all students identified by their Medicaid ID are automatically updated in the HealthOffice Anywhere database reflecting their months of eligibility and all students that were identified with Medicaid IDs using the 3-point match basis are compared, on a point-by-point basis with the respective student information in the database. Students matching all 3 points exactly are recorded as Medicaid eligible with their returned Medicaid IDs. Students that were partially matched (matching 1 or 2 of the criteria) are recorded in a 3-point match report reflecting the area of “mismatch”. Those students are reviewed by the district’s Medicaid coordinator for further action.

In the event that a student’s Medicaid eligibility is recorded in the state’s Medicaid system two or three months after the date the services were provided, as long as the student was Medicaid eligible when the service was actually provided, at the time Healthmaster obtains the eligibility information, Medicaid will be properly billed. As long as the Nurses, Special Education, and Mental & Behavioral health service providers and other healthcare providers properly document every student encounter, claims for all reimbursable services will be filed; the providers don’t have to worry about who is and who is not Medicaid eligible. If it's billable - it will be billed.

Once the submitted claims have been adjudicated by the state and the Medicaid HIPAA 835 remittance advice received, the information is processed in Healthmaster’s CARE system and any denied claims are segregated for correction. All information relating to paid and denied claims is securely forwarded electronically by Healthmaster and imported into the district’s HealthOffice Anywhere database. The paid claims are automatically reflected as paid in the student’s record and the denied claims are displayed, reflecting each denied claim and the reason for denial, enabling the appropriate person at the school district to quickly correct the claim or accept the denial.

All of this information is then incorporated into the student’s record in the HealthOffice Anywhere database; all corrected claims will automatically be resubmitted, together with new claims, in the next claims processing cycle. The results of all Medicaid claiming activity is maintained in the district’s HealthOffice Anywhere database; comprehensive detailed and summary reports of all billing activity including student eligibility and claiming activity are available at all times (24/7) to authorized District staff in a report format or in a spreadsheet format by:

  • Claim
  • Date or date range
  • Student
  • State Medicaid agency check number
  • Provider
  • school

The district is always in control with 24/7 access to all its Medicaid billing and reporting information as a part of its HealthOffice Anywhere database. Request a demo today to learn more about the Medical Billing Clearinghouse.