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School-based Medicaid program frequently asked questions

School-based Medicaid program FAQs

Administrative Activities Claiming (AAC)

  1. When do AAC claims need to be submitted in order to be included in a given quarter's claims processing?
    AAC claims are processed by the University of Massachusetts Medical School (UMMS) on behalf of MassHealth. Claims must be received by the UMMS Center for Health Care 15 days after the close of each quarter, for processing with that quarter's submission, with the following exception. If a claim must be processed in a given quarter in order to meet the two-year billing deadline, as specified in page 15 of the Claiming Manual for School-Based Administrative Activities (( AAC Claiming Manual)-Click on the Municipal Medicaid Publications Web page to find this document.), that claim must be received 15 days before to the close of the quarter. For more information on submitting AAC claims, please see the AAC Claiming Manual.
  2. Who should participate in the AAC time study?
    School personnel who perform reimbursable administrative activities should participate. Participation should be based on job function, not job title. Salaried, contracted, full-time and part-time personnel should participate in the time study. For more information, please see pages 16 and 17 of the Time Study Manual.
  3. Where can I find a Local Education Authority's (LEA) indirect rate, which is used in the AAC claim?
    Refer to the grants section of the Department of Education (DOE) Web site.
  4. How should time-study participants code a snow day or unplanned school closing?
    Activity code H should be used to code days when school is closed unexpectedly.
  5. How often is the Medicaid Eligibility Factor calculated?
    A new Medicaid eligibility factor must be calculated for each quarter's AAC claim.
  6. What information is contained in the list of MassHealth-eligible students sent to the LEA each quarter?
    This list, which may be used to calculate the Medicaid eligibility factor, contains the names of individuals ages three through 21 who were eligible for MassHealth on the fifth day of the first month in the given quarter. The list is limited to individuals residing in zip codes associated with a given LEA.
  7. To whom in the LEA will the list of MassHealth-eligible students be sent each quarter?
    The list will be sent only to the person who has signed Amendment #3 to the Municipally-Based Health Care Services Provider Agreement. To report changes to the person who should receive the list, please contact UMMS at
  8. Must all applicable personnel complete a time study or can LEAs choose a sample population?
    LEAs may choose a sample population of personnel within a job position grouping, but the sample must be both random and have a 95% confidence level, with plus or minus 5% precision.
  9. Must all time-study participants in a LEA complete the time study for the same five days?
    Yes. All time-study participants in the LEA must complete the time study for the same five days.
  10. Must the five time-study dates fall within a single calendar week, such as Monday through Friday?
    No. The time-study dates must be for five consecutive school days, but the days can fall into more than one calendar week. For example, time-study dates can be Tuesday through Monday.

Direct Service Claiming (DSC)

  1. Where can I find information on how to submit an electronic DSC claim?
    For information on submitting claims electronically, go to the Web-Based MassHealth Transactions page. For more information, you may also contact MassHealth Customer Services Center at 800-841-2900 or by e-mail at

  2. When do DSC claims need to be submitted in order to be included in a given quarter's claims processing?
    MassHealth processes claims within 30 to 45 days of receipt. To ensure that claims are processed with a given quarter's submission, they should arrive at MassHealth no later than 45 days before the end of the quarter.

  3. When must a LEA document health-related services? Municipal Medicaid providers must document health-related services provided to students pursuant to an individualized education plan (IEP) in order to submit claims under its Municipal Medicaid agreement.
  4. Must LEAs use the Municipal Medicaid service documentation form to complete this documentation?
    No. While an LEA may use the form, an LEA need only document, in any format, all of the elements listed in Municipally Based Health Services Bulletin 9. If this information is captured in a different format, it does not need to be transferred to the Municipal Medicaid service documentation form.

  5. Can LEAs claim for a student who has an IEP, but who does not have health-related services listed in the IEP?
    Yes. Through the bundled-rate structure, LEAs can bill for all special education Medicaid students, regardless of whether or not they have a health-related service in their IEP. However, all other claiming requirements must be met.

  6. Can LEAs bill for a student who is in attendance at school on a day that the student does not receive health-related services?
    Yes. Through the bundled-rate structure, LEAs can bill for all days that a student is in attendance, has a valid IEP, and is Medicaid eligible. However, all other claiming requirements must be met.

  7. How can LEAs verify MassHealth eligibility for students for direct service billing?
    A student must be eligible for MassHealth on the day that a service is delivered in order for the service to be reimbursable through the Municipal Medicaid program. LEAs can verify the MassHealth eligibility of their students using MassHealth's Recipient Eligibility Verification System (REVS).
  • To access REVS, you must have a user ID and password. To determine if you have a current user ID and password, call the REVS HelpDesk at 800-462-7738.
  • There are two methods commonly used by Municipal Medicaid providers to access REVS information.
  • You can directly matching student population to the eligibility information available on WebRevs. WebREVS is internet based REVS and allows providers to access member eligibility information. For information about WebREVS, contact the REVS HelpDesk toll free at 1-800-462-7738.
  • You can verify eligibility through REVS by calling the MassHealth Eligibility Operator toll free at 1-800-833-7582.
  • Go to MassHealth REVS for more information.
  1. What requirements related to parental consent must be met in order to bill MassHealth for services provided by an LEA?
    The Massachusetts DOE is the state agency with authority over any requirements concerning parental consent for LEAs to bill MassHealth for Municipal Medicaid services. For more information, contact Program Quality Assurance Services within DOE at 781-338-3700. Additional information may also be found on the DOE website at.

  2. Will billing MassHealth for services provided to a child under the Municipal Medicaid program through an IEP limit the total amount of services that MassHealth will pay for that child?
    MassHealth pays for all medically necessary services for a child that are covered by the child's MassHealth coverage type. Thus, if a child's medical needs exceed the services that the child may receive under the Municipal Medicaid program through his or her individual education plan (IEP), MassHealth pays for services needed to address those medical needs that are not provided in the IEP. However, MassHealth does require providers to obtain prior authorization before it will pay for certain services. The prior- authorization process determines whether MassHealth agrees that those services are medically necessary for the child. In considering requests for prior-authorization, MassHealth may review all services available to a member, including those provided under an IEP. If MassHealth determines through the prior authorization process that the services being provided under the IEP fully meet the child's medical needs, MassHealth will not authorize payment for any additional services.

Payment Information

  1. When are payments made?
    Municipal Medicaid providers receive separate quarterly payments for direct service and administrative claims. Payment is distributed approximately eight to 10 weeks after the close of the quarter.
  2. Where can I find an LEA's payment history?
    On the VendorWeb Web site: . A vendor code is required to access payment information. If you do not know your vendor code, please contact the University of Massachusetts Medical School at 617-886-8044 or by email


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