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PAIU Workgroup Meeting School-Based ACCESS Program. February 7, 2013. Agenda. Accomplishments SBAP Update Service Logs Billing volumes Exception Report Update Claiming Update RMTS Update MCRCS Update Medicaid Eligibility Next Steps – Action items.

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Paiu workgroup meeting school based access program

PAIU Workgroup MeetingSchool-Based ACCESS Program

February 7, 2013


  • Accomplishments

  • SBAP Update

    • Service Logs

    • Billing volumes

    • Exception Report Update

    • Claiming Update

  • RMTS Update

  • MCRCS Update

  • Medicaid Eligibility

  • Next Steps – Action items

Sbap service log activity through 2 5 2013


488 LEAs have submitted

1,434,075 service logs


491 LEAs have submitted

1,571,233 service logs

SBAP Service Log Activity (through 2/5/2013)


Pa sbap billing history july aug sept
PA SBAP – Billing History (July, Aug, Sept)*

Service Logs Processed

* Only months of July, Aug, Sept were processed, awaiting 2013 rates to be approved to process logs Oct 1 or later

Claiming update
Claiming Update

  • The FY13 district-specific billing rates have been established and approved by DPW

  • Claims will be generated and submitted by 2/14/13 for all services, all districts for the months of October – December 2012

  • Claims will also be submitted for July – September, 2012 by 2/15/13

  • Next claim run will be during the week of February 28, 2013

Exception report process
Exception Report Process

  • Part of PCG standard process for school-based billing programs is to conduct automated compliance/edit checks on all data prior to claim submission to DPW

  • Services that do not pass all checks are not claimed for, reports are generated illustrating why services did not pass

  • Reports are then distributed to LEAs

  • Initial exception reports were distributed first week of January, 2013

    • Response has been strong

    • 2nd claiming cycle showed vast improvements

  • This process ensures that districts have the documentation and data necessary to file compliant claims, reducing and eliminating audit risk

Random moment time study rmts
Random Moment Time Study (RMTS)

  • Q1 results(Oct – Dec, 2012)

    • Total moments 6,000 (both cost pools)

    • Total responses: 4,943

    • Response rate: 82.38%

  • Roster update for Q2(Jan – March, 2013)

    • Roster updates for Q2 completed December 7, 2012

      • 578 LEAs have rosters in RMTS

      • 54 LEAs do not have rosters in RMTS -- No EI programs

  • Roster update for Q3 (Apr – June, 2013)

    • Four week email, live webex campaign begins Feb 1

    • Weekly emails, weekly Q&A live webex’s

    • Roster updates must be completed by March 8, 2013

Rmts discussion items
RMTS Discussion Items

  • RMTS Calendars are obtained from each entity for the entire year

    • Calendar is updated with unscheduled days off (snow days, emergencies, etc.)

    • Calendars are all entered into the system, an algorithm is run on the calendars and the most consistent/common days/times result in a uniform/average PA calendar

    • No moments are distributed on days off based on this average calendar

  • RMTS Participants are all trained to answer system questions clearly and in a straightforward manner

    • Lunch time is an appropriate answer

    • Time off is an acceptable answer

    • Travel time between schools is an acceptable answer

Medicaid cost reporting claiming system mcrcs
Medicaid Cost Reporting & Claiming System (MCRCS)

  • Web-based tool for capturing allowable, actual costs from LEAs

  • Training dates have been announced via email & SBAP website

    • 1/31, 2/1, 2/4, 2/5, 2/6, and 2/8

    • Dates & times posted on Training Calendar for registration

    • ACCESS Coordinators & Business Managers are registering

  • MCRCS deadline for cost data entry is March 8, 2013

  • MCRCS is the web-based system created by PCG for school-based Medicaid programs. The purpose of the system is to:

    • Capture all allowable, reimbursable costs for both quarterly administrative claiming and annual cost reporting

    • If costs aren’t entered MAC claims and the cost report cannot be completed, impacting ACCESS reimbursement for districts

Medicaid matching
Medicaid Matching

  • PCG conducts a monthly Medicaid match on all students in EasyTrac

    • Match consists of ‘exact’ matches on name, DOB, and gender and secondary matches using parts of the first name, parts of the last name, DOB and gender

    • For secondary, or enhanced, matches PCG staff evaluate the detailed records from both files to determine if a match truly exists

    • If last name from the district records is completely different than last name from DPW records, match is not accepted

  • Significant audit risk exists if names between the two files don’t match or closely resemble one another

    • Worst case scenario with an auditor is to have a Medicaid ID assigned to wrong student and claims are being submitted

    • Nicknames, shortened names, hyphens, apostrophes, middle initials, etc are all causes for matches to fail

    • Process is for district to engage parent and have misspelling or name changes updated in DPW or district files, whichever is incorrect