Third-Party Medicaid Billing Services
Overview
Fit Score
Settle Intelligence
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SUMMARY
DESCRIPTION
The issuing organization is seeking a vendor to provide third-party Medicaid billing services in Texas. The selected provider will support Medicaid Administrative Claiming (MAC) and School Health and Related Services (SHARS) through both in-person service delivery and a secure web-based Medicaid billing platform. The scope is intended to support an estimated 500 to 600 students.
Required services include administrative support, assistance with claim data entry, support for tracking parent consents for billing, and assistance with calculating the direct medical services individualized education program (IEP) ratio. The vendor will also be expected to provide reporting support and a secure web-based claim entry system integrated with the Frontline special education management system.
The provider must maintain full support during internal and external audits, including practice audits, documentation of processed claims, and preparation of necessary reports and correspondence. Additional responsibilities include tracking and reconciling paid claims, following up on denied or held claims, resubmitting rejected or denied claims, and ensuring compliance with legislative and other applicable requirements. Questions are due by May 13, 2026, and the contract term is one year.
Source attribution
This Settle analysis is based on the issuing organization’s public RFP listing.