Medicaid Claiming and Billing for Schools

Revenue recouped from school-based, Medicaid reimbursable health services is a vital source of funding. With limited resources, state and local education agencies (LEAs) and school districts may struggle to keep up with evolving Medicaid policy and compliance rules that govern federal reimbursement opportunities.

Public Consulting Group (PCG) can help you optimize reimbursement, achieve compliance, reduce paperwork, and gain insights. We're a national leader in school-based Medicaid engagements. Since 1992, the firm has helped education clients recover more than $7 billion in federal Medicaid funds for school health services across the U.S. – more than any other vendor in the country. With more than 4,000 clients ranging from small rural districts to state agencies, we understand that no two Medicaid programs are alike. Using a unique approach to each client, we provide the time, technology, and expertise needed to recover the optimal amount of allowable funds.

Why PCG?

PCG has successfully navigated the school-based Medicaid environment for our clients for more than two decades. Our approach is focused on making school-based Medicaid programs efficient and compliant in order to recover the maximum amount of allowable reimbursement. We offer:

  • Technology to reduce staff burden
  • Actionable reporting to help effectively manage the program
  • Superior customer service
  • Policy and audit support
  • National and local perspective


Easy-to-Use Technology

PCG provides clients with comprehensive service and time saving technology. Our online solutions reduce the burden on school staff by saving time and facilitating compliance.


EasyTrac™ - Direct Service Documentation

Web-based tool for efficiently documenting service delivery and maintaining compliance data related to fee-for-service (FFS) claiming. EasyTrac provides a single data source for your Medicaid process. A secure, low-cost, mobile-ready version of EasyTrac optimizes the logging screen for Apple® and Android® devices and offers:

  • Faster entry of session logs
  • Higher percentage of session logs documented
  • Reduced hardware costs for LEAs
  • Reduced time between the session date and data entry
  • Integration with EDPlan™ platform 


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EasyRMTS™ - Time Study Solution

Online time study approach and random moment methodology that allows for convenient documentation of administrative outreach activities that comply with federal statistical requirements. EasyRMTS eliminates the paper chase – no more lengthy time study training required for administrative claiming!

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EDPlan Connect™ - Caregiver Portal

All-in-one caregiver portal that promotes increased family involvement in a child’s education—whether it’s signing an Individualized Education Program (IEP), consenting to bill Medicaid, or prescribing services via Order/Referral. EDPlan Connect allows parents and other essential individuals in a child’s education, such as teachers, administrators, and doctors, to securely access information, documents, and action items regarding a student. With EDPlan Connect, caregivers have a centralized, secure place to:

  • Access student records online and in their native language
  • Sign documents electronically and save time
  • Receive automatic and personalized notification from key stakeholders
  • Stay up to date with student progress


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Operations and Support

FFS billing

Service data is reviewed and submitted in HIPAA compliant format by PCG on behalf of the client.

Program implementation

PCG provides oversight and on-going support with district enrollment, program expansion, monitoring, audit responses, policy creation and dissemination, and district
communication regarding the program.

Third Party Administrator (TPA) services

PCG offers upfront claim reviews to determine quality and compliance prior to processing by a state Medicaid agency. Claims passing review are submitted to the Medicaid
agency by PCG for adjudication.

Consulting Services

Audit services

Whether local, state, or federal, PCG can assist with every part of the audit process, including responding to reviews and negotiating financial findings.

Data analysis/reporting

PCG offers in-depth data analysis and reporting to identify trends, outliers, and possible areas for reimbursement growth. We assist school boards, superintendents, or
other stakeholders to provide information on the Medicaid claiming process.

Medicaid consulting

Our in-house experts on policy, national trends, program improvements, pending or recently passed legislation offer helpful and up-to-date information to help inform program implementation at a local level.

Program review

PCG conducts a thorough review of the current Medicaid program, either at the state, district, or LEA level, resulting in a written report of recommendations for process or
policy improvements.

Rate setting/cost settlement

PCG analyzes and establishes appropriate rates and/or performs a cost settlement process to ensure all allowable costs are captured and reimbursed to the client.