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Third Party Billing


More Information
 

 

What is Third Party Billing? 

Minnesota law (M.S. 125A.21) requires that school districts seek reimbursement from private and public health insurers for the cost of health-related services provided to students who receive special education services. Reimbursements can be collected from third party sources such a Minnesota public heath coverage (MA or MinnesotaCare) and/or private insurance.

If your child receives health-related services as part of their IEP, IFSP, or IIIP, a member of your child's team may ask your permission to share information with your insurer and/or physician in order to bill for these services.

Health-related services are developmental, corrective and supportive services that are required in order for a student to benefit from their program of specialized instruction. Health-related services include supports such as:

  • Diagnosis, evaluation and assessment;

  • Speech, physical and occupational therapies;

  • Audiology;

  • Assistive Technology devices;

  • Personal care assistant (PCA) services; 

  • Mental health services;

  • Special transportation; and

  • Health services such as nursing. 

We are asking for your support

If your child is currently eligible for MA/MHCP, please consider signing the consent form to release records to the Minnesota Department of Human Services (DHS) for billing purposes. The records released may include your child's IEP, IEP health related services documentation, and medical orders. If you ask, we will send you copies of the records we share for billing.

While districts in the ASEC are required to seek payment from both private and public insurers, our districts will seek to bill only public insurance Medical Assistance (MA), TEFRA, and MinnesotaCare (MC). Billing public insurance has no impact on your child's or family's medical coverage. ASEC school will not bill private insurance, as doing so could cause your insurance rates to increase and/or have other negative effects on your child's and family's insurance coverage. If your child is covered both by private insurance and MA.MHCP, the district will ask your permission to contact your private insurer to seek a denial of coverage (private insurers typically will not pay for services provided by schools). Once the district receives letter of denial your public insurance can be billed.

If your child was at one time determined eligible, but you decided not to participate due to financial feasibility with your private insurance or other reasons, please consider allowing MA/MHCP for IEP services only. A disparity agreement allows the school to bill for IEP services for students eligible for TEFRA without the family incurring any parental fees.

Assurances 

One of the most important things to know is that Minnesota laws offer protections to parents and students when schools bill MA or MC. These protections include:

  • Services provided by the district and paid by MA or MC do not count toward any monthly, annual or lifetime limits for the same or similar services.

    • For example, if your child's IEP includes occupational therapy services, it does not affect therapy service limits your child might need or receive from a rehab agency. 

  • Services provided by the district and paid by MA or MC do not count toward any home care or waiver caps.

    • For example, if your child's IEP includes staff to assist with eating and toileting, it does not affect the amount of personal care assistant services your child can receive at home.

  • Services provided by the district and paid  by MA or MC do not affect services your child gets from other providers, or those covered by a PMAP.

  • There are no parental fees nor co-pays for services provided by the district and paid by MA. 

  • Services provided by the district and paid by MA does not count toward a spend down. 

  • There is no penalty to you or your child for not participating. All services your child needs while in school will continue to be provided at no cost to you.

What Happens to the Money?

Minnesota laws are very specific about the use of money districts get from third party billing. There are several things you should know:

  • If your district gets money from third party billing, it does not reduce any other state aide the district gets for education or special education.

  • Payments from third parties for services given to your child do not go directly to offset costs for your child.

  • Money your district gets for third party billing can only be used for three things:

    1. For the benefit of students with special needs in your district;

    2. To pay for the cost of doing third party billing; and

    3. To get training and help to increase the amount of third party billing. 

ASEC does not bill your district for the cost of billing or for training. All the dollars generated by your district go to your district to support special education services.

 

You support and cooperation is greatly appreciated by your district.