Third Party Billing Explained
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. 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;
- Paraprofessional/personal care assistant (PCA) services;
- Mental health services;
- Transportation; and
- Health services such as nursing.
While districts are required to seek payment from both private and public insurers, Minnesota New Country School will seek to bill only public insurance Medical Assistance (MA) TEFRA, and MinnesotaCare (MC). Billing public insurance has no impact on your child’s nor family’s medical coverage. Minnesota New Country School will not seek to 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 we have received a letter of denial, we will then bill your public insurance.
One of the most important things to know is that Minnesota laws offer protections to parents and students when schools bill MA or MS. These protections include:
- Services provided by the district and paid by MA or MS 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 MS 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 MS do not affect services your child gets from other providers, or those covered by a PMAP.
There are not 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 spenddown.
Minnesota law requires that any money received from MA billing can only be used for three things:
- For the benefit of students with special needs within the district,
- To pay for the cost of doing MA billing, and
- For training and help to increase the amount of MA billing.