Our client is a state education agency that is responsible for providing transportation services to public school and charter school students in the state, including students with disabilities. Transportation services are only eligible for reimbursement when they are provided to students who receive health services on the same day – and those services have been reimbursed. However, because individual school districts in the state are responsible for providing and claiming for health services, our client had difficulty navigating data privacy issues and integrating the required data from the state’s public and charter school districts to match claimed health services to transportation services in order to accurately identify transportation services that were eligible for reimbursement.
In order to implement transportation claiming for our client, Accelify developed a customized version of AcceliROUTE, a comprehensive transportation management and claiming tool. The AcceliROUTE system was set up to import our client’s transportation ridership data and other claiming validation data including transportation IEP authorization, paid health service claim data, and student information.
The system uses this data to automate the process of matching students’ transportation services to claimed health services in order to identify those that are eligible for Medicaid reimbursement. This complex validation processes occurs prior to claim submission, ensuring only eligible trips are submitted, reducing denial rates and eliminating the very tedious process of manually matching trips to paid service claims.
Accelify’s work has allowed the state education agency to tap into a significant source of revenue that was not possible prior to implementing AcceliROUTE. Utilizing the system, our client was able to recoup a total of $2.5mm in transportation claims in year one, which included $1.4 in retroactive transportation claims that would have otherwise been lost.
The client continues to claim an average of $1.4mm in annual transportation Medicaid claims and is expanding the program to claim for transportation services provided to non-public school students for the 2015-16 school year.