Major Shift in Utah Medicaid Claiming Process for School-Based Health Services

The Utah Department of Health has announced that schools in the state will be transitioning from the Medicaid Bundled Billing Plan to a Fee-For-Service plan for the 2021-2022 school year.  Utah’s switch from a Bundled Billing model to a Fee-For-Service model will make it easier for all districts to participate in the Medicaid claiming process and to receive reimbursements for the important services they deliver to students.

Primary data requirements of the Fee-for-Service model:

  • Student is Medicaid eligible on date of service
  • Student is being evaluated or is eligible for Special Education services
  • Medicaid claimable service is listed in the IEP
  • Service type being provided to student is documented
  • Date of service session
  • Time length of each session
  • Documentation of service activity, related to specific IEP goals

Typically, service data is gathered electronically on a monthly basis and organized by the district or by a Medicaid vendor who then submits it to the state Medicaid agency for claim processing.

How Embrace® Can Help

The Embrace® platform makes it easy for service providers to document the services they deliver.

  • Service documentation is secure and protected on a HIPAA compliant site
  • EmbraceIEP® and EmbraceDS® programs are integrated together. They share real-time information regarding IEP goals, service minutes, and can generate monthly accuracy reports
  • Service delivery documentation can be accessed at anytime from almost anywhere
  • Staff can document services from any web enabled device
  • Consistent communication between Embrace® and district staff to assist in maximizing reimbursement opportunities
  • Monthly accuracy reports compare the prescribed services listed on the IEP to the delivered services for the month to ensure accuracy of delivery

Embrace® has over 15 years experience with the Fee-for-Service billing model and is looking forward to supporting Utah's EmbraceIEP® clients with transitioning to the new Medicaid claiming model.

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