Frequently Asked Questions

Related Services

• Occasionally, we hear the schools have received additional funds through the Office of Third Party Billing. Can we access these funds? Related Services money goes into the fund for providing equipment, extra positions and to fund a variety of other needs for special education and health related services. However, you could let your principal or IEP Chair know you are in need of something and it would be up to each individual Principal to decide how the money will be spent for their school.
• If I am eligible for more than one title, what should I do? If you were a designated case manager and a related service provider you would complete both areas of the encounter form. Your title should reflect your primary job duty.
• Can I submit encounter data if I attend a team meeting? Yes, you can bill for services provided at the IEP team meeting if the child is present.
• What happens to the funds generated by the Related Services program? Related Services money goes into a fund for providing equipment, extra positions and to fund a variety of other needs for special education and health related services.
• Should the child be present when we submit encounter data for a consultation? All services provided by psychologists must be face-to-face contact with the child and specified in the child's IEP.
• Can I bill for my initial assessment? All related service providers can bill for initial assessments. Educational assessments are not reimbursable services according to the Medicaid guidelines.
• Can we bill for students who are on a 504 plan? No, services provided to students who are on a 504 plan are not billable.
• Do all services have to be on the IEP in order to bill? Yes, for a student to be eligible for Third Party Billing, all services must be delineated in the IEP.
• We provide services to students who attend several schools. How can we ensure that we receive credit for our services, not the home school? The student can only have one designated case manager. The Case Manager is the only person who should submit encounter data forms for IEP Team meetings or monthly coordination of services. Several staff members may provide services relating to case management activities; however, ONLY ONE STAFF MEMBER SHOULD SUBMIT ENCOUNTER DATA FOR CASE MANAGEMENT SERVICES TO THE OFFICE OF THIRD PARTY BILLING. If you are uncertain whether you are a child's Case Manager please consult your IEP Team Chairperson.
• Can we bill for educational assessments? No, unfortunately, this is an "educational service" that cannot be submitted to Medicaid for reimbursement.
• Can I submit my case management and related service encounter data on the same form? The encounter data form is designed to allow providers to submit case management as well as related service encounters on the same form.
• What is the school number? Where can we find this information? The school number is a four-digit number that helps other schools/offices identify your school immediately. You may find this information on the list of eligible students sent to you monthly, in the school telephone directory or the secretary at your school can give you the information.
• I received a related services training manual, but no newsletter or list of students who are eligible at my school. What should I do? You should call the Office of Third Party Billing at 4130 and we will be happy to send or fax you a copy of the newsletter and a list of students who are eligible at your school.
• An individual at my school requested that I complete an additional log of contacts, and submit it to her on a monthly basis for Third Party Billing. Is this accurate? This is not accurate. According to the Medicaid guidelines, all information that must be maintained for Third Party Billing is on the Encounter Data Form. You do not need to complete additional logs as documentation.
• I have submitted all of my related service encounter data forms for the month prior to the last day of the month. Why have they been returned to me? You cannot submit encounter data forms prior to the actual date of service. This could be considered to be fraudulent. As a result, the Third Party Billing system will not accept dates of service before the occurrence, or if schools are closed.
• I understand that children in foster care are automatically eligible for Medicaid. Is this true? Yes, this is true. Students who are placed in foster care are eligible for Medicaid for the first six months of their placement. After that time, it is the responsibility of the foster care family to renew the Medicaid benefits.
• In some cases, I may provide two services in a day (i.e. a group setting in the morning and an individual session in the afternoon). Unfortunately, you can only document one service per student per day for Medicaid billing purposes.
• Can we document more than one related service in a day? No, you may only document one related service per student per day.
• What should we do if we provide services to a child whose name is on both school reports? If the name of a child appears on both reports, your encounter should be submitted on the wellness center encounter data form.
• We had a child who had an IEP that was only for vision services. Who is the appropriate case manager? In this instance, the appropriate case manager is a person who is routinely in the building, not the individual providing the vision services.
• When will we receive our reports of eligible students? On a monthly basis, Third Party Billing will send a report to your school that will delineate which students qualify for the Third Party Billing program. You should receive a report on or about September 29, 2006.
• When can we submit encounter data retroactively to the beginning of the school year? When a student's name appears on the monthly Active Special Education Students Matching Medicaid File listing, you may submit encounter data forms for that child retroactive to nine (9) months prior to the child's name appearing on the listing. The child's IEP and MA number must have been active during that time.
• Why do the names of students leave and return to our monthly printouts? The computer printout for your school will change on a monthly basis. The list will be updated when students enroll or withdraw from your school, or when students change their Medicaid eligibility status.
• How do we get more encounter data forms? You may make additional copies of the encounter data form. The Office of Third Party Billing will accept any color paper you wish to use to when photocopying the encounter data form. If you do not have an original encounter data form, you may also call the Office of Third Party Billing at 4130 and we will send you additional encounter forms that you may photocopy.
• What should happen with the Third Party Billing registration forms? Please share the Third Party Billing brochures with your special education families and to families at your Back-to-School Night. Once the registration form is completed, please send it to the Office of Third Party Billing in Timonium. You may send the form through our inner-office mail.
• When are our encounter data forms due into the Office of Third Party Billing? Please send your encounter data forms into Third Party Billing at the end of each month.
• If I provided an individual therapy session the morning and a group therapy session in the afternoon, can I submit encounter data for both? No, you may only document one related service per student per day.
• If I provide services twice in one day for a child, can I submit encounter data for both occurrences? Medicaid regulations are very specific about accepting multiple services by discipline provided for a child on the dame day. For instance:
  • Medicaid allows Speech Language Pathologist, Occupational Therapists, Social Workers, Psychologists and Physical Therapists to submit only one related service visit date and procedure code per day for each child they service.
  • However, school Social Workers and school Psychologists share similar procedure codes, and must decide which provider will submit fore related services rendered to the same child on the same day. One single date submitted by two different providers who share similar procedure codes is not allowable.
  • School Nurses may submit up to three different procedure codes on a single date for billable services provided to students.
• I service a child in the use of sign language. As a provider, can I submit encounter data for this service?No, Medicaid does not allow this related service to be billed. However, if the child has only classroom services listed in the IEP and you are the only person providing services, you may submit for case management services.
• As a related service provider who also performs case management services can case management encounter dates be documented on the related service portion of the encounter data form? No, case management services should only be documented on the bottom portion of the encounter data form.
• When photocopying, should our encounter data form be on blue paper? The encounter data form does not need to be photocopied on blue paper. The Office of Third Party Billing will accept any color paper.
• I recently submitted all of my encounter data forms for the months of September through December before the winter break. Is this acceptable? This method of submitting encounter data forms is permissible by Medicaid regulations, but is not very helpful for the final recovery effort. The Office of Third Party Billing requests that encounter data forms be completed and submitted at the end of each month. The use of this process allows for the Office of Third Party Billing to establish a higher percentage rate of reimbursement, which leads to more funds for special education and health related services.
• When can I submit retroactive encounter data? You may submit retroactive encounter data when the name of a student appears on your Medicaid list for the first time, and you have been providing services to the student during the year.
• Can the Occupational Therapist be a case manager? The Occupational Therapist would be the case manager for a student who has an IEP strictly for Occupational Therapist Services.