Direct Service Billing
Medicaid regulations allow Local Education Agencies (LEAs) to be reimbursed for providing direct health services to students who are eligible for Medicaid benefits. Paradigm helped develop the LEA direct service billing program during California’s pilot project in 1993. Over the years Paradigm has applied its unparalleled expertise to become the billing vendor of choice for school districts and county offices of education.
Direct Service Program Implementation
Paradigm makes it easy. We provide you with all the necessary materials to help you establish your direct billing program. We will
- provide all required start-up applications so you can enroll as a Medicaid provider
- provide initial and ongoing support, consultation, and technology to identify and track qualified health care providers that can bill for services
- provide your school with Paradigm's web-based direct service billing technology. Student Health Network (SHN ™) records student services and electronically manages your caseloads
- provide detailed and frequent reporting on and analysis of your program to help you increase participation and revenue
- provide an assigned account manager to guide you through the program and furnish individual support
Program Maximization
Successful billing is driven by provider participation and senior administrative support. Comprehensive provider trainings and support are vital, as are accurate and complete health care service data. Paradigm developed its systems with the health care provider in mind, creating intuitive tools to help you get the most from your programs. Paradigm provides
- on-site provider and manager trainings
- quarterly and annual tune-up sessions, including annual regional managers-only conferences
- an easy-to-follow provider manual in both paper and electronic formats containing the most current program regulations and definitions
- a fully staffed client care center and help desk for both coordinators and participants to answer all your questions accurately and in detail
Full Audit Support
With its thorough understanding of program rules and regulations, our audit-ready support staff ensures that your Medicaid revenue stays with you. Paradigm provides
- on-site support for state and federal reviews before, during, and after your review
- an annual (at minimum) compliance review to keep you audit ready
- comprehensive best practices training, materials, and support
Paradigm clients have been reviewed and audited by both state and federal agents with successful results.