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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/10/02

School-Based Health Services – Fee-for-Service Claims Adjustments

​To: ​Local Education Agencies
​Date: ​December 10, 2002
​Re: ​School-Based Health Services – Fee-for-Service Claims Adjustments

Over the next six to eight weeks, Local Education Agencies (LEAs) may receive remittance advices from the Department of Public Aid (DPA) reflecting corrections to reimbursements made under the School-Based Health Services Fee-for-Service program. These changes result from corrections to an edit in DPA's claims processing system. Up to this point, the edit did not correctly reimburse payments at the lesser of the LEA's costs or DPA's fee-for-service cost limit. The U.S. Department of Health and Human Services Office of the Inspector General's recent audit of the fee-for-service program identified the error.

The remittance advices will show adjustments to claims by student. These adjustments could be either positive or negative. Adjustments are being run against all claims in the Department's database that were priced incorrectly. These claims are being adjusted back to January 1998 through September 2002. The adjustments to the fee-for-service program monthly payments will be made in phases over several months. Negative adjustments will be posted against future payments. Please do not remit payment to the Department for any negative adjustments.

If you have any questions, please call 217-785-1754.