When your district provides health-related services as part of students’ IEPs, 504s, or Health Plans, it’s important to ensure that your special education staff have a reliable monthly Medicaid billing checklist. This helps your special education team submit claims accurately and on time, allowing the district to receive reimbursement for eligible services.
So, what should you include in this checklist?
To assist Illinois special educators, our Embrace® Medicaid Success Team has prepared a list of essential requirements for successful Medicaid billing claim submission. More than 500 EmbraceDS® customers are already benefiting from having all these requirements built right into the software. As an EmbraceDS® customer, you also receive personalized guidance from our Medicaid Success Team and are notified if and when certain requirements are not met.
If you’re not yet an EmbraceDS® customer, you can still use this article to compile your own checklist and improve Medicaid billing compliance in your district—or reach out to our Sales Team to book an EmbraceDS® demo today.
To submit a Medicaid claim, you’ll need the student’s Medicaid Number, also known in Illinois as the Recipient Identification Number (RIN).
Here's where and how school districts can obtain it:
Parental consent is required before a district can bill Medicaid for services provided to a student. However, verbal consent is not sufficient. Consent must be signed by the student’s parent or legal guardian, and it may be obtained either with a physical signature or an electronic signature during the IEP process.
It is important that your staff informs parents/guardians that the school may seek reimbursement from Medicaid for certain services and use the Consent to Bill Medicaid form as part of the IEP paperwork. EmbraceDS® customers benefit from collecting electronic signatures fast and easy via our online Parent Portal.
Additionally, claims can only be submitted for dates of service on or after the date consent was signed. So, if a parent or a guardian does not provide written consent until April of a school year, the district may not bill for services provided prior to April.
Lastly, new consent must be obtained if a student transfers to a different district. For instance, if a student is moving from an elementary feeder district into an independently-established high school district, new consent will need to be obtained by the receiving district. EmbraceDS® automatically checks consent status and updates a dashboard with a list of students that are missing consent.
For students receiving Speech, Audiology, Physical Therapy (PT), or Occupational Therapy (OT) services, Medicaid requires documented medical necessity in the form of a prescription or referral before claims can be submitted for reimbursement. Submitting claims without a valid prescription or referral can result in claim denial or compliance issues during audits.
How to identify whether you need a prescription or a referral:
The active prescription or referral must be entered and tracked on the Student Information Page in your Medicaid billing program. In EmbraceDS® Medicaid billing system, coverage periods are carefully validated.
IMPACT (Illinois Medicaid Program Advanced Cloud Technology) is the enrollment system used by the Illinois Department of Healthcare and Family Services (HFS). It serves as the official registry of Medicaid-approved providers in the state.
If a provider — such as a physician, nurse practitioner, or other qualified practitioner—writes a prescription or referral for Medicaid-billable services (e.g., OT, PT, speech therapy), their information must be:
Certain Medicaid claims—such as those involving services delivered by support personnel like Physical Therapist Assistants (PTAs) — require supervisor or cosigner approval before they can be submitted. This is because Medicaid regulations mandate that only qualified providers can authorize and bill for services.
For instance, when a PTA delivers therapy, a licensed Physical Therapist must review and cosign the claim to:
1. Confirm the service was provided under their appropriate supervision.
2. Verify the service was clinically appropriate and aligned with the student’s treatment plan.
3. Ensure compliance with state licensure laws and Medicaid billing rules.
In EmbraceDS®, supervisor or cosigner approval can be provided in just a few clicks. To approve pending claims, supervisors can go to the top menu panel and select EmbraceDS® > Supervisor/Cosigner. Then, click on each student’s month hyperlink to view and approve (or deny) claims.
In order to submit Medicaid claims through your Medicaid billing software, like EmbraceDS®, all providers who enter billable services must be included in a billable cost pool, specifically a PCG (Public Consulting Group) cost pool.
What is a PCG Cost Pool? A cost pool is a group of qualified staff members, such as Speech-Language Pathologists, OTs, PTs, nurses, psychologists, and others — who:
These cost pools are used by the state to determine how much reimbursement a district is eligible to receive for the services delivered by school-based providers.
It’s important to update cost pool rosters regularly to include new hires, contracted providers, or role changes. As an EmbraceDS® customer, you’ll get support from our Medicaid Success Team when/if your district encounters any cost pool errors, to ensure all eligible staff are listed in an active PCG cost pool.
Finally, to be eligible for reimbursement, claims must fall within the timely filing window for School-Based Health Services to be submitted to the state for reimbursement.
Timely filing for IL schools is 180 days from the date of service. This means that if a claim is submitted after 180 days, it will be denied—even if all other billing requirements are met.
If you don’t have internal expertise in Medicaid billing, you might want to consider working with a vendor like Embrace®, which can provide not only software but also personal assistance and help you manage the Medicaid billing process, reduce errors, and improve reimbursement rates.
Book the EmbraceDS® demo below!