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Agencies Involved
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Agencies Involved
 

New Jersey Department of the Treasury, Division of Administration, Office of Fiscal and Resources

New Jersey Department of Education, Office of Special Education (DOE)

New Jersey Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS)

New Jersey Department of Children and Families (DCF), Office of Education/Campuses

Public Consulting Group (PCG)

Local Education Agency (LEA)

 

New Jersey Department of the Treasury, Division of Administration,
Office of Fiscal and Resources
(Back to Top)

  • Serves as Contract Manager for its contract with Public Consulting Group (PCG) to administer the SEMI program.

New Jersey Department of Education, Office of Special Education (DOE) (Back to Top)

  • Coordinates the process for board approval for participation
  • Certifies LEAs for participation in the SEMI program
  • Provides policy guidance

New Jersey Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS) (Back to Top)

  • Conducts Medicaid provider enrollment
  • Issues Medicaid provider numbers to LEAs
  • Provides Medicaid technical assistance
  • Communicates requirements of program specifics to ensure that Federal Medicaid regulations are followed
  • Processes and adjudicates claims through its fiscal intermediary, UNISYS

New Jersey Department of Children and Families (DCF), Office of Education/Campuses (Back to Top)

  • Conducts Office of Education evaluations
  • Provides Medicaid technical assistance and transportation to DCF Campuses
  • Appoints a SEMI Coordinator to coordinate with PCG in fulfilling the operational responsibilities for SEMI
  • Verifies that student services submitted to PCG for Medicaid claiming are included in the student's IEP which is valid for the dates of service
  • Verifies that service providers have the appropriate qualifications or credentials for Medicaid billing

Public Consulting Group (PCG) (Back to Top)

  • Receives and processes Billing Agreements (Electronic Data Interchange) from newly Medicaid enrolled LEAs
  • Receives from LEAs and processes verification of parental consent to bill Medicaid
  • Provides a toll-free Help Desk to provide technical assistance to LEAs regarding SEMI service documentation issues
  • Conducts Medicaid eligibility verification for New Jersey students
  • Provides initial user names and passwords for LEA provider documenting services on EasyTRAC
  • Provides training to providers for service documentation using EasyTRAC and/or paper related service documentation forms.
  • Prepares and submits to DHS claims for Medicaid reimbursement consistent with Medicaid billing requirements
  • Provides on-going Medicaid legal and regulatory compliance monitoring

Local Education Agency (LEA) (Back to Top)

  • Pre-enrolls with the Department of Education to certify LEA status by submitting board approval for participation in SEMI program
  • Completes the Medicaid Provider Application package to enroll as a Medicaid provider with the Medicaid program and receives a unique seven-digit Medicaid provider number which will be used for billing purposes
    • Completes the Medicaid Provider Application package
    • Obtains assistance, as needed from the Medicaid office to complete the various forms included in the application package
  • Designates PCG as the LEAs' Medicaid billing agent
  • Appoints a SEMI Coordinator to coordinate with PCG in fulfilling the LEAs operational responsibilities for SEMI
  • Verifies that student services submitted to PCG for Medicaid claiming are included in the student's IEP which is valid for the dates of service.
  • Verifies that service providers have the appropriate qualifications or credentials for Medicaid billing.
  • Verifies that signed written parental consent to bill Medicaid has been obtained prior to submitting service records to PCG for Medicaid billing.
  • Verifies that transportation services billed to Medicaid are: (1) for transportation on specialized vehicles; (2) included in the student's IEP; (3) for a student who received another Medicaid covered service on the day transportation is billed; and (4) for a student who actually used the transportation service
  • Monitors service documentation compliance by related service providers and conducts necessary follow-up
  • Submits Time Study and Financial Data.
 

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