Medicaid Services Setup

Classic View: System Administration > Medicaid > Services

Search Terms: Medicaid Services

The Medicaid Services editor lists each service that can be assigned to a student and used in the Medicaid Billing process. States define what services can be billed for Medicaid reimbursement. Services may not change much over time, but the rates with the services do. It is advised that state requirements on Medicaid Services be reviewed often.

Screenshot of the Medicaid services setup tool.Medicaid Services Editor

This information should be historical, Deletion of previous rates is not necessary; however, the old rate should be marked inactive and the new rate should be entered.

Typically, the state Medicaid agency will issue a list of billable services, billing codes and billing rates. Each service must be associated with a Service Group (General, Transportation, Paraprofessional or Medical). This drives the fields available to collect data in the Service Log as well as what reporting may be done.

Add Medicaid Services

  1. Select the New Medicaid Service button from the Services tab. A Medicaid Service Detail will appear.
  2. Enter the Name of the service.
  3. Determine if this is an Active service. An active service is any service that is currently being offered to students.
  4. Enter the Service Number.
  5. Select the Group associated with the service. Options are General, Transportation, Paraprofessional or Medical.
  6. Enter the Modifier options. Modifiers (1-4) are defined with the service number.
  7. Select the Service Location from the dropdown list. This selection is the location of where the service is typically provided. 03: School is the default selection.
  8. Enter any Comments associated with the service.
  9. Click the Save button when finished. The new Medicaid Service will appear in the Service List. Service Rates will now need to be created.

Screenshot of the services tool with the New Medicaid Service button highlighted.New Medicaid Service

Medicaid Service Locations

Code

Description

01

Pharmacy

03

School

04

Homeless Shelter

05

Indian Health Service Free-standing

06

Indian Health Service Provider-based

07

Tribal 638 Free-standing Facility

08

Tribal 638 Provider-based Facility

11

Office

12

Home

13

Assisted Living facility

14

Group Home

15

Mobile Unit

20

Urgent Care Facility

21

Inpatient Hospital

22

Outpatient Hospital

23

Emergency Room - Hospital

24

Ambulatory Surgical Center

25

Birthing Center

26

Military Treatment Facility

31

Skilled Nursing Facility

32

Nursing Facility

33

Custodial Care Facility

34

Hospice

41

Ambulance - Land

42

Ambulance - Air or Water

49

Independent Clinic

50

Federally Qualified Health Center

51

Inpatient Psychiatric

52

Psychiatric Facility - Partial Hospitalization

53

Community Mental Health Center

54

Intermediate Care Facility/Mentally Retarded

55

Residential Substance Abuse Treatment

56

Psychiatric Residential Treatment Center

57

Non-res Substance Abuse Treatment

60

Mass Immunization Center

61

Comprehensive Inpatient Rehab

62

Comprehensive Outpatient Rehab

65

End-Stage Renal Disease Treatment

71

Public Health Clinic

72

Rural Health Clinic

81

Independent Laboratory

99

Other Place of Service

Add Medicaid Service Rates

  1. Select the Medicaid Service for which to add rate information from the Service List. Non-editable information (minus the Active checkbox) will appear in the Medicaid  Service Detail box to the right. Users can also select the Service Rate button without first selecting the service.
  2. Select the New Service Rate button from the Services tab.
  3. Select the appropriate service from the dropdown list to associate the new rate with the correct service.
  4. Enter the Effective Date of the rate.
  5. Enter the Unit Measurement. This is simply a number that defines the increments.
  6. Select the Increments of Measurement. Options are minutes, hours or miles. If the unit entered is 30 and the increment selected is minutes, the service would have the rate of 30 minutes of service for the entered dollar amount.
  7. Enter the Rate for the service.
  8. Click the Save button when finished. The most current rate will appear as the first rate below the associated service and in bold.

Screenshot of the services tool with the New Service Rate button highlighted.Add Medicaid Service Rates

Once rates are entered and saved, they cannot be modified. If a rate is entered in error it may be deleted unless it has been used on a service log entry. If the Medicaid agency changes the rate for a particular service, a new service rate should be entered. The effective date will determine which rate is current and which rate is billed for the service.