Frequently Asked Questions

Encounter Data Forms

• Can we make templates of the encounter data form and photocopy? It is very important to make sure your information on the top portion of the encounter data form is correct in order to avoid reoccurring errors. Errors will result in the encounter data form being returned to the IEP Chair each month. You may complete the top portion of the encounter data form and then make copies. I would suggest only making a few copies at first to see if any problems arise when the data is entered.
• Why did my school receive less Third Party Billing funds than in previous years? There could be a variety of reasons for receiving less Third Party Billing funds. Some examples are:
  
  • You had fewer students eligible for Third Party Billing at your school for the 2007-2008 school year than in the previous year.
    
  • Some of the claims submitted may not have been eligible for Medicaid.
    
  • You may have failed to send an encounter for each of the students on your eligible list of students the 2007-2008 school year.
    
    All of these things could lead to receiving less Third Party Billing funds.
    
    
• Where do we direct our encounter forms? You will still send your encounter forms to the Office of Third Party Billing, Timonium Business Park, through inter office mail.
• We have a pediatric consultant who provides services to students. What title code should he use? We will add a title code on the encounter data form for the pediatric consultant. Until that time, the pediatric consultant should write in the title.
• We have a substitute classroom teacher. Who should sign the encounter data form? If the substitute classroom teacher is degreed, she/he may sign the encounter data form. If the substitute classroom teacher is not degreed, they may provide the service and have a co-signer sign the form; this may be the IEP Chairperson or Assistant Principal. You must have submitted a registration form to the Office of Third Party Billing which included the name of the substitute(s).
• How are we held accountable for submitting our Third Party Billing encounter data forms? Starting in November, the Office of Third Party Billing will publish our "report card." The "report card" will delineate the number of case management services provided by each case manager. This report can be utilized to ensure that all Third Party Billing encounter data forms are submitted.
• What information should we share with Occupational Therapists and Physical Therapists? Case managers do not need to share information with Occupational Therapists or Physical Therapists. They have a separate training session and can only be a case manager if the child receives only OT services or PT services delineated in the child's IEP.
• In some cases, we have students who withdrew in the middle of the month. What school will receive credit for the case management encounter? In this instance, if you provided a case management service during the time the student was enrolled at your school, you should submit an encounter data form for the student and your school will get the credit for the case management encounter. It is; however, courteous and a big help to the Office of Third Party Billing to let the IEP chair at the new school know that you have already submitted an encounter form for the student for that month. This helps prevent duplicate forms being submitted to the Office of Third Party Billing.
• Can we use the previous encounter data forms from the previous year? The Office of Third Party Billing will no longer accept the previous data encounter forms from previous years from school-based staff. A new encounter form will be sent to you in the September mailing.
• How many case management encounters can be submitted in a month? You may only submit encounter data for one service per month, regardless of the number of consultative activities that may occur during that month.
• Is an original signature required on each encounter data form? Yes, an original signature is required on each encounter data form.
• When should we send our encounter data forms into Third Party Billing? Please send your encounter data forms into the Office of Third Party Billing at the end of each month. In order to ensure that your forms are submitted timely for a bi-monthly report, be sure that your forms reach the Office of Third Party Billing by the seventh (7th) of the following month.
• What should I do if I have an IEP team and monthly case management in the same month?In this case, your encounter data form should reflect the IEP Team meeting.
• I received my encounter data forms returned stating that my encounter is a duplicate, but it is not. Why has this form been returned? The word "duplicate" means that the Office of Third Party Billing has received another case management encounter data form for the same month for this student. In most instances, the form in question has been submitted by another colleague in your school. To avoid this problem, talk to your IEP chair in order to reaffirm who is the case manager.
• Should we photocopy our encounter data forms prior to sending them to the Office of Third Party Billing? It is suggested that a copy of all encounter data forms be kept by the provider. However, you only need to retain the copies of the encounter data forms until the end of the current school year.
• Should each provider complete his or her own forms, or should we share? Each provider should complete his or her own form since an original signature is required on each form.
• Can a case manager submit encounter data for related services? No, as a case manager, you cannot submit encounter data for related services.
• Should we sign the encounter data form in certain color ink? The encounter data form should be signed in red or blue ink. A signature in black ink can give the appearance that it has been photocopied. An original signature must appear on each form. The encounter data form is a legal document therefore it must be signed in ink.
• We may hold an intake conference team meeting for a child. Can we submit encounter data for this service? You may submit an encounter data for this service using Code 930, 931, 932, 933, 934, 935 IEP Review Modification. Be sure to attach the notes from the intake to the encounter form when submitting it to the Office of Third Party Billing.
• What should we write in the related services area of the encounter data form? As a case manager, you do not need to use this area of the encounter data form.
• Do you have any suggestions on ways that we can track the submission of encounter data forms? Yes, please use the Third Party Billing Case Management Tracking Report located in your training manual on page 27. This is a good tool for monitoring forms submitted by one person or an entire staff.
• What is the time frame for maintaining our copies of encounter data forms? Providers should keep copies of the encounter data forms submitted to the Office of Third Party Billing through the current school year.
• How should we use the Third Party Billing Case Management Tracking Report? (Page 27) In September, when you receive a list of eligible students from the Office of Third Party Billing, you should enter the name(s) of your eligible students on the checklist (page 27).  After an encounter data form is completed, you should then put a check mark in the column next to the student’s name that matches the month of the encounter form. For the remainder of the school year, you should check the monthly eligibility list to determine the students for whom you provide case management services and add these names to page 27 of the Case Management manual. Remember when a student’s name appears on the monthly Active Special Education Students Matching Medicaid File listing, you may submit encounter data forms retroactively to the date that the registration form was signed. The signed registration form must be on file with the Office of Third Party Billing. The child’s MA and IEP must also have been active during that time.
• I understand that there is a rule that the case management encounter be dated the first Monday of the month. Is this correct? Medicaid guidelines change from year to year. During the summer of 1998 Medicaid guidelines changed regarding this question. Medicaid now delineates the case management encounter data form must have the actual date that your case management occurred (This information can be found in the directions on the back of all encounter forms). It would be erroneous data if all encounters were dated the first Monday of the month and would lead to serious problems in the occurrence of an audit.
• Our school did not receive a Third Party Billing award. How can we find out what encounter data forms were missing so this does not happen again? You may call the Office of Third Party Billing at 4130 and we will be happy to run a report for your school showing the encounters that your providers submitted for the 2007-2008 school year. We also suggest you use the case management encounter data form-tracking device located in your training manual as Exhibit H. This is a good tool for monitoring forms submitted by one person or an entire staff.