Know before you bill
Every service is checked against Medicaid requirements first. When something is missing, you see what and why.
From the therapy session to the paid claim.
K12Claim helps school districts turn documented Medicaid services into accurate claims, and shows exactly what to fix when a service can't be billed.
-
Session logged
The provider records the session.
Received -
Eligibility check
Consent, order, license and diagnosis are checked.
Needs a fix: order is dated after the service Order corrected -
Batch review
Your billing and compliance teams sign off.
Approved -
Submitted
The claim goes to Medicaid electronically.
Accepted -
Paid
Payment is posted to the claim.
Paid
An illustration with sample data.
Everything between the session note and the payment
One place for the people who document care, the people who bill for it, and the people who answer for it.
See what is holding up revenue
Dashboards show which services did not qualify, the reasons, and the dollars involved, so fixes go where they matter most.
Review that fits your process
Look over each batch, add notes, hold claims back, and send questionable ones to compliance before anything goes out.
Submission and tracking
Claims are sent electronically. Responses and payments come back and update every claim automatically.
Denials worked to the end
A work queue for rejected and denied claims, with suggested corrections, approvals and resubmission in one place.
Find anything fast
Search across claims, batches, denials and responses from one box, and look up a student's Medicaid eligibility on demand.
Alerts that reach the right person
Get notified when a batch is ready for review, when new problems appear, or when a file is late.
Your people, your rules
Roles and permissions, single sign-on with your own identity provider, and a record of who did what and when.
Built for the services districts actually bill
School-based health services have their own rules. K12Claim applies them for each kind of service.
Therapy
Occupational, physical and speech-language therapy.
- Individual and group sessions
- Telehealth sessions
- Weekly frequency from each student's plan
Skilled nursing
Nursing visits delivered during the school day.
- Registered and licensed practical nurses
- Supervision and co-signature
- Orders and diagnoses checked
Special transportation
Trips that students need to reach their services.
- Trip logs tied to delivered services
- Vendors and vehicle requirements
- County rates applied
How it works
Five steps from your district's records to claims that get paid.
Bring your data
We load your students, providers, orders, consents and sessions from the files your district already keeps.
Check eligibility
Every service is tested against Medicaid requirements. Anything that fails comes with a reason and a way to fix it.
Review the batch
Your billing and compliance teams review, adjust and approve what will be sent.
Submit
Approved claims go out electronically, when you decide.
Follow through
Track responses and payments, and work every denial until it is resolved.
Clear for everyone who touches a claim
Finance and billing
See what is ready, sent, paid and at risk, with the numbers behind each.
Special education and providers
Find out what documentation is missing while there is still time to fix it.
Compliance
Approve before submission, limit who can do what, and keep a trail of every change.
See K12Claim with your district's workflow
Tell us about your district and we will set up a walkthrough with your billing, special education and compliance teams.
Email us to request a demo Please do not send student or health information by email.