Customize Medicaid Claim Billing Logic – DnA & ISE

This article helps to guide admins through the process of customizing the billing logic applied to Medicaid billing submissions.

For additional information you can contact us via e-mail at help@illuminateed.com or by telephone at (517) 224-4499.

Note: This feature is permissions based. Please contact your system administrator if you require access to these features.

Where to Start

To access the Medicaid claim rule setup

For ISE only users select Medicaid -> Billing-> Claim Rule Setup.

For Multi-product users select Special Ed -> Billing-> Claim Rule Setup.

Setup Claim Rules

1. Indicate which claim rules you would like to enable by selecting "Yes" from the dropdown.

2. Click the "Submit" button when finished.

Note: Logic for the Non-Calendar Day filter is directly tied to the calendar in Illuminate. You will need to setup your calendar or all claims will be rejected. This must be done by building. If you need assistance, please contact your Customer Success Manager for help setting up your calendar. In addition, the logic for the Non-School Day: Holiday filter is directly related to federally recognized holidays. If this filter is flagged as "Yes" all encounters logged on any federally recognized holidays will be rejected.

Next Steps

You have now successfully customized your Medicaid Claim Rules.

If you are still having trouble customizing your Medicaid Claim Rules please contact us via e-mail at help@illuminateed.com or by telephone at (517) 224-4499.