Medicaid Billing Agency
June 2, 2003
To: Superintendents of Public School Districts;
Directors of Special Education
School District Business Officials
County Executive
County Administrators
Central New York Regional Information Center
Regional Information Centers
From: Robert J. Scalise, Coordinator, Medicaid Services Unit
Re: Medicaid Central Billing Agency for the School Supportive Health Services Program and the Preschool Supportive Health Services Program (SSHSP & PSHSP) in New York State
In response to inquires from several school districts regarding authorized billing agents for these two programs, this memorandum provides information regarding this issue.
All school districts and all counties, outside the City of New York, must submit Medicaid claims through the current Medicaid Central Billing Agency in New York State for the School and Preschool Supportive Health Services Program (SSHSP & PSHSP). Central New York Regional Information Center (CNYRIC) is the sole Medicaid Central Billing Agency for these programs in New York State outside of the City of New York. New York City is approved to submit claims directly to the State Medicaid Agency. Although some school districts and counties contract with private providers to create the Medicaid Claim, that claim must be submitted through the CNYRIC in the same manner all school districts and counties must submit their claims. CNYRIC will assure that all Medicaid claiming transactions are compliant with the Health Insurance Portability and Accountability Act (HIPAA).
The November 10, 1993 Memorandum of Understanding (MOU) between the Department of Social Services (now the Department of Health (DOH)) and the New York State Education Department (SED) provide that "SED shall be responsible for establishing a system to assure that the school districts bill the medical assistance program only for those types of services which are Medicaid reimbursable".In order to assure that school districts and counties are claiming only for those types of services, which are Medicaid reimbursable, SED, must maintain control over the billing system, including edits that will ensure that certain controls are in place. SSHSP and PSHSP were approved by the Health Care Finance Administration with certain limitations, which include the implementation of edits, by a Central Billing Agency with direct oversight by SED and DOH.
The school districts and counties, outside the City of New York, currently submit their claims through their Regional Information Center (RIC) to the CNYRIC. The New York State Education Department (SED) and the Department of Health (DOH) are able to perform a Statewide match from data at the CNYRIC with the names and Client Identification Numbers (CINs) of students that are Medicaid eligible which are then provided to school districts and counties. In addition, the system provides reports to assist Special Education Directors, School District Business Officials and County Administrators in maximizing Medicaid revenue and assist in the completion of the supplemental reports required for state aid in their ST-3 Report. The system allows for school districts and counties to submit claims on a monthly basis through the CNYRIC.
SED and DOH are reviewing changes to the systems that will allow school districts and counties to submit claims directly to CNYRIC through the WEB. The claim submission through the WEB will include an encryption method to ensure that all confidentiality requirements are met. By maintaining a Central Billing Agency for all SSHSP and PSHSP providers, SED and DOH can ensure all data submitted by school districts and transmitted to MMIS through the CNYRIC meet all the State standards for confidentiality. In addition, once the Health Insurance Portability and Accountability Act (HIPAA) Regulations are finalized, we can also ensure compliance with this act as well.
Thank you for your cooperation in this matter.
cc:Michael Albino
Richard Billera
Thomas Hamel
Lorraine Illenberg
Robert J. Scalise