Third Party Medicaid Administrative and Recovery Services

School District of Jefferson County Public Schools

Buyer requires a third-party administrator to manage administration and direct billing of fee-for-service Medicaid programs for school-based health services. The provider will handle claims processing, manage service documentation, and ensure regulatory compliance. Provider must offer a comprehensive web-based tool for service logging and documentation with robust reporting capabilities. The system must integrate with district data systems and support high volumes of service logs from multiple providers.

• 5/13/2025 - Proposal Due Date
• 7/1/2025 - Contract Start Date
• 6/30/2026 - Contract End Date (Initial Period)

• Five years or more successful administration of Medicaid billing in schools
• Ability to ingest minimum of 750,000 service provider logs annually
• Provide documentation of $1 million surety/fidelity bond

• Manage new and existing claims for Medicaid billing
• Provide web-based service documentation tool for service providers
• Review district records to identify billable medical services
• Process and submit claims to Medicaid
• Provide training on parental consent requirements
• Monitor regulations and policy changes related to Medicaid
• Generate reports on claims status and service provision
• Facilitate data exchange with district information systems
• Represent district during Medicaid program audits
• Provide quarterly on-site Medicaid consultant services