MSB NH Fall Start-up | July 24, 2013  


2013 - 2014 Fall Start-up Checklist


It's that time of year again! This email is a reminder of those items that MSB requires in order to make the Medicaid Program successful this school year!


This email contains information on the following:

  • District Information Forms (DUE: August 16th)
  • Rate Information (DUE: August 23rd)
  • Extended School Year Rates (DUE: August 23rd)
  • School Intakes (DUE: September 6th)
  • Lumea:  Required Administrative Items (DUE: September 6th)
  • Special Education Student Rosters (DUE: October 4th)
  • Out-of-District Roster (DUE: October 4th)
  • Specialized Transportation Roster (DUE: October 4th)

District Information Forms (DUE: August 16th)


To assist us with maintaining an accurate contact database, please fill out the District Information form found by clicking here


You can fax, email or mail this completed form to your Claims Analyst.  

2012-13 Extended School Year Rates (DUE: August 23rd)


A separate rates template will need to be submitted for those service providers providing 2012-13 ESY services.  


Please email your completed rates templates to  

Rate Information (DUE: August 23rd)


MSB will be emailing your district's 2013-2014 rates template request. 


Things to remember when completing your rates template:

  • Ensure all fields in the template are completed (Days per Year, Hours per Day, etc.). You can verify this by looking at the last column on the spreadsheet titled, "COST/UNIT WITH INDIRECT RATE". If you see #DIV/0! in this column, not all fields have been completed.
  • Include all Federally Funded staff, amount funded and whether or not you want us to bill for the staff member(s).
  • Include contracted staff and self-employed staff on this document as well.
  • The sooner we receive your completed rates template, the sooner your district will receive reimbursements!  We cannot submit any billing for your district until this information has been provided.
Please email your completed rates templates to

Please note: If your district would like to implement MSB's List of Excluded Individuals and Entities (LEIE) verification services, you must include each service provider's date of birth on the rate template. Please contact Kim Tortoriello if you would like more information regarding MSB's LEIE verification services.  

School Intakes (DUE: September 6th)


A new school intake form, including all service providers eligible to provide Medicaid-covered services, is required for all school locations within your school district.  Please click here to access our school intake forms.


Please fax, email or mail these to your Claims Analyst.   

Lumea:  Required Administrative Items (DUE: September 6th)


Attached you will find a document that outlines all required items that must be completed by a District Administrator in order for MSB to submit claims for reimbursement. If you would like instruction or support regarding any of these items, please contact Jana Dalton who can provide you with personal support and detailed instruction.  

Special Education Student Roster (DUE: October 4th)


Please provide MSB with the following information for your in-district students:

  • Student Name
  • Date of Birth
  • Medicaid ID (if applicable)
  • District of Liability
  • School Name
Please fax, email or mail this list to your Claims Analyst.  

Out-of-District Roster (DUE: October 4th)


In order to help maximize your Medicaid reimbursement, please provide MSB with the following information:

  • Student Name
  • Date of Birth
  • Medicaid ID (if applicable)
  • District of Liability
  • Out-of-District Placement (Name of Facility or SAU)
  • 402 Status (Yes or No)
Please fax, email or mail this list to your Out of District Claims Analyst.  

Specialized Transportation  Roster (DUE: October 4th)


Please provide MSB with the following information for students receiving IEP ordered Specialized Transportation:

  • Student Name
  • Date of Birth
  • Medicaid ID (if applicable)
  • District of Liability
  • 402 Status (Yes or No)
  • Bus Monitor (Yes or No)
  • Transportation Vendor and Contact Information (also note if parent or district)
Please fax, email or mail this list to your Transportation Claims Analyst.  

On-Site Training


MSB offers on-site district training on a variety of topics.  On-site training is provided to staff that either develop IEPs via Adori or document Medicaid-covered services via Lumea.  Reserve your times now as fall is very busy for all of us.  Please contact your Program Specialist to schedule on-site training for your district.  Districts will be scheduled based on availability of MSB staff on a first-come, first-serve basis.  MSB will make every effort to accommodate your request for on-site training.  Please contact Jana Dalton as soon as possible if you would like an on-site training this fall.


Topics for On-Site Training typically include:

  1. Adori Case Manager, Team Leader and Service Provider training
  2. Lumea (Medicaid) Admin, Team Leader, and Service Provider Training
  3. Service Provider Training for Medicaid-Covered Services
  4. Medicaid training for Case Managers and Administrators 



MSB can also offer webinars on a variety of topics related to school-based Medicaid, including working with Lumea and Adori.  If your district staff members have questions about a particular topic, and a webinar best suits your needs, please contact Jana Dalton to schedule one.

We hope you have a great start to the school year!  Don't forget MSB is only a call  or click away.



phone: 800.618.3111

fax: 603.692.0857