Role of School District Contact / Role of SWWC Assistants
The school district Medical Assistance (MA) Third Party Billing (TPB) contact person plays a vital role in the success of their TPB program. They are the communication bridge between all MA billing staff members and SWWC TPB Assistants.The success, integrity, accountability and consistency of the program depend, in part, on their involvement.
The school TPB contact person (Addendum B) acts as the liaison between the school district staff and SWWC TPB Assistants to:
•Notify all IEP health care providers, including SWWC providers, of students with MA eligibility;
•Confirm with case managers which Individual Education Program (IEP) health related services are MA billable;
•Relay changes/updates of new students to SWWC TPB Assistant staff;
•Adhere to Minnesota Department of Human Service (MDHS) IEP Provider Manual regarding all MA requirements;
•Identify and confirm names/licensure of MA billable qualified providers (QP) including Personal Care Assistant (PCA) supervisor;
•Ensure PCA supervisor confirms completion of all documentation for PCA billing including:
  • MDHS PCA Certification
  • Annual PCA Training including Plan of Care for student
  • Mini Time Study
  • Behavior Data CollectionSheets
  • PCA Activity logs
•Ensure providers complete all of the activity logs by the 15th of the following month of services;
•Obtain MA consents on all new SpEd students;
•Verify MA set-up is complete on SpEd Forms;
•Provide Annual Notice of ProceduralSafeguards (NPS)to ensure billing will continue unless school receives revocation;
•Disseminate any information from SWWC TPB Assistants to appropriate staff that directly affects the billing process; and
•Coordinate training efforts necessary for successful MA billing. / SWWC Third Party Billing (TPB) Assistants ensure every member district special education staff, including case managers, Personal Care Assistants (PCA) supervisors, direct service providers and business managers through face-to-face training, emails, meetings and other communication have the necessary tools for a successful TPB program.
SWWC TPB Assistants will:
•Provide support needed to maintain the integrity, accountability and consistency of the TPB program;
•Provide the tools necessary to ensure school districts are compliant with federal and state protocol set forth by law;
•Work directly with Minnesota Department of Education (MDE), Minnesota Department of Human Services (MDHS) and Minnesota Department of Health (MDH) to provide “rural and cooperative” insight and assist these organizations in the development of systems and methods to maximize third party revenue to our member districts.
•Provide MA eligibility lists of students;
•Obtain required private insurance denials before billing MA;
•Provide case managers and other providers with tools to ensure Individual Education Program (IEP) meet requirements outlined in the MDHS IEP Provider Manual;
•Batch files for billing.
•Reconcile Remittance Advice (RA) including issues regarding denials, primary and secondary payment errors;
•Provide internal audits upon request;
•Submit Annual Data Reporting worksheets to MDHS that are necessary to establish interim and final billing rates;
•Work with Business Managers regarding Electronic Data Reporting System (EDRS) for rate setting; and
•Provide on-going training, updates and support through workshops, email and other communication to ensure a successful TPB program for school district members.

March 2016