Compliance Services
In today's volatile climate of health care regulatory enforcement, every school district regardless of size, needs a compliance plan to help them avoid audit trouble with the Centers for Medicare and Medicaid and the Office of Inspector General and to mitigate the damage if trouble occurs.

 

Customized Compliance Program For Your District . CompuClaim’s compliance program is integrated throughout the whole billing process. Prior to implementing a compliance solution we sit down with the school Medicaid team and identify an Action Plan that will become the source document for daily guidance on all aspects of the Medicaid program. The Action Plan also becomes a critical document when retrieving data for a state or federal audit. The Action Plan includes the following components and more:


· Reviews of provider licenses and operating procedures,

· Directives and training for employees,

· Monitoring and auditing mechanisms,

· Procedures and systems for corrective action.


Service Capture Module. We offer a service capture tool is modeled after an electronic health record, but scaled to meet the needs of school-based providers. This Service Capture Module contains a series of internal controls and measures to ensure that providers enter data following federal, state and local statutes and regulations. If you have another service capture tool in use, we can easily adapt and accept imports that contain the proper billing data.


HIPAA Compliant Software. Our billing software is continually being upgraded to streamline your Medicaid claims and payment process. Below a sample of the capabilities of our billing solution:

  • Send and receive professional 835/837 HIPPA compliant claim transactions with your state
    Medicaid agency
  • Send and receive 270/271 Medicaid eligibility inquires to your Medicaid agency so that your Medicaid lists are always up to date and accurate.
  • Import capability designed to accept any file format from any data source, including all Web-based IEP systems and any Student Information System.
  • Add-on compliance review and oversight support services to oversee your Medicaid billing program.
  • Add-on calendar provider log system for your providers to log their services.
  • Dozens of reports to maintain mange and maximize your Medicaid claiming opportunities.
  • Built in compliance and audit checks to protect you from Medicaid reviews and audits.
  • Rapid online reports for each claims submission batch.
  • Denials management reports.
  • Electronic auto-posting (ERA) of payments directly back to charges (where available)
  • Overall reduced reimbursement cycle