Third Party Billing

1. Third Party Billing • For Service Coordinators • August 2019

2. Service Coordinators What is a claim? Records a billable service rendered to a student with special needs Identifies recipient of service, date of service, type of service, diagnosis code, provider of service, and amount charged for the procedure Same as the claim submitted by your physician to your health insurance after an office visit. What is Third Party Billing? • Federally funded program • Pursues Medicaid reimbursement of some costs of direct and administrative services under IDEA • Submits Medicaid claims to recover costs of some medical-related services provided to children who receive specialized services.

3. Service Coordinators Who can provide services? A clinician currently licensed by Maryland Department of Health: Occupational Therapist Physical Therapist Speech/Language Pathologist Audiologist Social Worker Psychologist Licensed Professional Counselor A clinician currently certified by the Maryland State Department of Education: Advanced Professional Certification Standard Professional Certification What is a false claim? • Federal Offense • Contains any of the following false info • Incorrect student • Service did not occur • Provider reporting the service did not render the service • Incorrect or false date of service • Incorrect or false type of service

4. Service Coordinators How do I get to the Third Party Billing web site? Go to the City Schools’ website. Select Staff Member.

5. Service Coordinators How do I get to the Third Party Billing web site? Scroll down to Popular Pages. Select Third Party Billing.

6. Service Coordinators How do I get to the Third Party Billing web site? Select TPB/SAS System.

7. Service Coordinators How do I log in? Logon using your network ID and password.

8. Service Coordinators Your Promise Before each use, you promise to not commit Medicaid fraud. Report your services only.

9. Service Coordinators Printing the Parental Consent Letter Medicaid cannot be billed without the parent’s consent. Go to the Reports tab. Click Consent Form Creator.

10. Service Coordinators Printing the Parental Consent Letter Search for by student ID, last name, or first name. Highlight the student’s name and click to select.

11. Service Coordinators Printing the Parental Consent Letter Select the language. Click Create Form. Verify the student’s information, which will be pre-printed on the letter. All student information must be printed from the system. There are no exceptions.

12. Service Coordinators Printing the Parental Consent Letter If you are the Primary Service Coordinator for the student, this letter must be completed and distributed before any services can be reported for billing. Print your name and the names of two (2) alternates. Sign. All signers must have Standard or Advanced Professional MSDE Certification. Make a copy and give the original to the student for the parent’s signature. After the parent signs, send a copy to Third Party Billing Room 201.

13. Service Coordinators Reporting Service Coordination Your name is displayed here. Click the SC tab. Report services that you provided.

14. Service Coordinators Reporting Service Coordination If your student is not listed, Search Students. You may need to scroll down to get to the button.

15. Service Coordinators Reporting Service Coordination Type the student’s pif, last name, or first name. Click the highlighted entry, then Search to pull your student.

16. Service Coordinators Reporting Service Coordination Mouse over Update to use the hyperlink. Click Update to enter services.

17. Service Coordinators Reporting Service Coordination Reported services are displayed. Student info is from Online IEP and cannot be changed.

18. Service Coordinators Reporting Service Coordination Use the calendar widget to select the date you provided the service.

19. Service Coordinators Reporting Service Coordination Use the drop down list and click the service you provided. First service of the year is Sent Parent Service…Form.

20. Service Coordinators Reporting Service Coordination Outcome Statement is automatically generated. Click submit to promise placing supporting documentation in the student’s confidential folder.

21. Service Coordinators Reporting Service Coordination Verify the information you entered. If correct, click Submit. If incorrect, click Back and make corrections. The service has been reported.

22. Service Coordinators How do I view reports? Go to the Reports tab and click on a report. The Transaction History Report lists your reported meetings for two quarters.

23. Service Coordinators How do I view reports? Transaction History Report opens in a new window. It displays services for the logged-in provider. Choose Current Month, Current Quarter, or Prior Quarter and click Run. If you do not get a report, click on the box with the red ‘X’. Allow pop-up blocker for SAS. Click Done, then Run.

24. Service Coordinators Transaction History Report Displays services for students reported by the logged in provider. Available for Current Month, Current Quarter, and Prior Quarter. Save trees. Do not print these reports. Close both report tabs to return to the Reports Menu.

25. Service Coordinators Service Coordination Report SC Report displays ‘1’ for reported services. Missing services are indicated by ‘.’. Report end date is previous month. TPB Compliance percent has been added.

26. Service Coordinators Printing the Service Coordination Activity Log • The Service Coordination Activity Log and supporting documents should be placed in the student’s folder when any of the following occurs: • Student transfers mid-year; • Student is dismissed from service mid-year; • School year ends. • Select the SC tab. Find your student. Hold Ctrl –P and click print.

27. Service Coordinators Review of Session Activity If your session has not expired, when you select the Log Out tab, you get a summary of your session activity.

28. Service Coordinators Frequently Asked Questions What are examples of billable service coordination? Billable service coordination may include: • Meetings/conferences with child or parent/guardian; • Progress reports/IEP report cards; • Letters concerning the student’s IEP progress; • Telephone calls…NOT messages left on an answering machine; • Home visits; • Emails (printed). Who can be a service coordinator? A Special or Regular educator who is most familiar with the student’s needs, who coordinates the student's IEP, and is certified by the state of Maryland with a Standard or Advanced Certificate. Related Service providers with Speech only students are service coordinators for those students.

29. Service Coordinators Frequently Asked Questions Can a student have more than one service coordinator? No. The student must have one primary and at least one alternate coordinator. The primary service coordinator must be certified, identified on the IEP by name and title, and approved by the student’s parent/guardian. The alternate service coordinator(s), also certified, should appear on the Service Coordination/ Medical Assistance Coordination Consent letter sent to the parent. The primary coordinator is expected to provide services and enter service details in the Third Party Billing System. What are the responsibilities of the service coordinator? • Provides coordination of care compliant with the IEP; • Makes contact with the parent/guardian and/or student throughout each month; • Participates in the planning and implementation of the IEP; • Places appropriate supporting documentation of services in the student’s confidential folder; • Reports service details in the Third Party Billing System by the last day of the month in which services occur. • Sends a copy of the Service Coordination/ Medical Assistance Service Coordination Consent Form to Third Party Billing after the parent signs it;

30. Service Coordinators Frequently Asked Questions Under what conditions should service coordination be reported to TPB? • The student must have an IEP. Service coordination cannot be billed for students who are not enrolled in special education; • There has been a direct contact (by meeting, visiting, telephoning, or writing) with the parent, guardian, or student; this direct contact occurs expressly to coordinate the IEP. When can the Parental Consent Form be sent home? On the student’s first day on your case load. How will I know my services have been reported to TPB? Verification is provided after the 2nd submit, at the end of your session when you click on the Log Out tab, and via the reports function. Can I bill for 504 or Service Plans? No. Students with 504 Plans or Service Plans are not billable.

31. Service Coordinators Third Party Billing Call Third Party Billing at 410-396-8948 for TPB System and Provider Support. Information Technology will not be able to assist you with TPB System issues.