ERIC Number: ED334792
Record Type: RIE
Publication Date: 1991-Jan
Reference Count: N/A
Accessing the Health Care Financing System: A Resource Guide for Local Education Agencies. Bulletin No. 91298.
Wisconsin State Dept. of Public Instruction, Madison.
This guide is intended to assist Wisconsin school districts in accessing the health care financing system as a means of supporting specialized services. Topics covered include: determination of a local education agency's potential for third-party covered services; the need to become a certified provider dependent upon the funding source; determination of whether local education agency staff meet the qualifications necessary to become a certified provider; establishment of a system or mechanism to document relevant treatment-services data and translate that data into an appropriate third-party claim; and obtaining parental consent. Individual chapters address the following areas: (1) historical background--legal basis for third-party claims; (2) cautions in accessing third-party funds and gaining parental support; (3) delivery of health care services in an educational setting; (4) the Wisconsin Medical Assistance Program coverage of medically necessary services provided in the schools; (5) the health care financing system (including military coverage, state programs, private commercial plans, funded plans, and managed care alternatives); (6) documentation; (7) collection and transmission of treatment data; (8) insurance claim form preparation; (9) the life cycle of an insurance claim; (10) reporting third-party reimbursements; and (11) the "make or buy" decision. Extensive appendixes provide sample forms and documentation. A glossary and list of 11 state resources are also included. (DB)
Descriptors: Ancillary School Services, Disabilities, Educational Finance, Elementary Secondary Education, Financial Support, Health Care Costs, Health Insurance, Health Services, Medical Services, School Districts, School Support, Special Health Problems
Wisconsin Department of Public Instruction, Bureau for Exceptional Children, 125 South Webster St., P.O. Box 7841, Madison, WI 53707.
Publication Type: Guides - Non-Classroom; Reference Materials - Vocabularies/Classifications
Education Level: N/A
Audience: Administrators; Practitioners
Authoring Institution: Wisconsin State Dept. of Public Instruction, Madison.
Note: Some pages of appended material contain small type.