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Service Claim Processing

Audited Service Claim Documentation

Services provided to all students are documented daily in each respective HealthOffice® Anywhere Module.

Once activated, the Billing Module offers complete control of the billing process.

Using the Medicaid documentation functionality integrated into all HealthOffice Anywhere application modules:

  • Medical diagnosis, procedure codes, and other required information are recorded automatically by the use of templates, or individually, as a part of documenting each encounter.
  • The specific ICD-9/10 code is recorded at the time any scheduled nursing, special education, or mental & behavioral health procedure is initially set up to ensure proper, automatic coding when the scheduled event is performed and documented.
  • All of the state-specific billing procedure codes and modifiers for each job classification are recorded as part of the initial configuration, and the software automatically restricts use of specific codes to each billing provider based on the specific job position that was assigned as part of each user’s initial set up.
  • The professional license(s), including expiration dates and qualifications of each user are recorded, and the user and her/his supervisor are notified prior to license expiration.
  • Parent permissions are tracked, and a claim is not allowed to be submitted if the district does not have appropriate parent permission on file.
  • A Medicaid claim for a provider needing a supervisor’s review of the documentation will not be submitted unless the approval is documented and attached as part of the event record.
  • A claim to be submitted for any scheduled event where the student has been recorded as absent will not be allowed.
  • The program verifies that the particular school was in session on the day of service prior to transfer of billing information to Healthmaster’s Medicaid claim processing service to better ensure the accuracy of each claim for purposes of submission and of audit.
  • Service claims can be easily batched and submitted to Healthmaster for processing in any manner desired: individually, by discipline or type, by provider, by school, by date range, etc.

The HealthOffice Anywhere Medicaid service claim functionality provides assurance, as much as possible, that:

  1. a specific professional
  2. with a valid, current license
  3. provided specific, documented services
  4. authorized for that professional to provide
  5. to a specific Medicaid eligible student
  6. with current Medicaid eligibility and a valid Medicaid number
  7. on a specific day that the school was in session
  8. where the student was not marked absent
  9. recording a valid ICD9/10 code and Medicaid procedure code authorized to be used by that professional
  10. containing, when necessary, a supervisor’s approval and authorization
  11. the district has the proper parental permission to bill on file

Our service claim processing software ensures that information is submitted accurately and completely. Request a demo today to learn more about our service claim processing.