Service authorization match
Every claimed service must be authorized in an IEP or IHP, with the specific service, frequency, and duration — verified against delivered logs.
The most rigorous school-based Medicaid claim pack a district can submit.
ScholarClaim assembles a documentation-complete claim and audit-defense package — every service authorization matched to delivered logs, every provider license verified, every parental consent checked, and every cost report substantiated — checked against federal and state Medicaid rules before a licensed clinical reviewer releases it.
Every element of 42 CFR §440.180 and state Medicaid plansFive statutory claim elements, gate-checkedIEP/IHP · service logs · licensure · consent · eligibility searchesLicensed clinical reviewer release on every pack5-business-day SLA
Why claims fail
A single missing documentation element can trigger a six-figure disallowance.
A district's Medicaid reimbursement is only as strong as the documentation behind it. Miss a service authorization, skip a provider-licensure check, fail to document parental consent, or misalign a service log with an IEP — and the claim can be denied, disallowed, or trigger an OIG audit that claws back millions.
Most districts run this by hand, from memory, with one overstretched coordinator. The federal and state rules have not been read end-to-end since the last audit. That is exactly where documentation gaps hide.
ScholarClaim exists to close that gap with a single, exhaustive standard applied identically to every claim.
1 of 5
missing documentation elements is enough to jeopardize a claim
The benchmark
Measured against the letter of federal and state Medicaid rules — subsection by subsection.
We do not summarize the law and hope. Every claim is scored against a versioned rule pack tied to the exact text of 42 CFR §440.180 and the applicable state Medicaid plan. These are the provisions each pack is held to.
Provider licensure and scope
The rendering provider's license, certification, and scope of practice are verified as active and matching the service delivered.
Parental consent and eligibility
Parental consent for Medicaid billing and student Medicaid eligibility are confirmed for each claim period.
Documentation completeness
Service logs include date, duration, location, and a description of the service — all elements present or the claim does not release.
Cost report substantiation
Each claim is linked to a cost-reportable activity, with time-study or other allocation methodology evidenced.
Audit trail and retention
Every claim file includes a complete audit trail: source documents, extraction logs, reviewer notes, and retention schedule.
How a claim pack is built
Intake to licensed reviewer release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A licensed clinical reviewer signs every release. That order is never reversed.
01
Documentation Gap Scan
Upload service logs, IEPs, and provider files. We return a free completeness read: which claim elements and searches you already have, and which are missing.
02
Evidence & eligibility searches
As your authorized clerical agent, we order provider-licensure checks, Medicaid eligibility verification, and parental-consent confirmation, and build the claim matrix.
03
Grounded drafting
The five claim elements are drafted from your validated data and the §440.180 rule pack into field-locked templates — no legal opinions, no invented facts.
04
Deterministic completeness gates
Service authorizations reconcile to logs; provider licenses are verified; consent and eligibility are confirmed; cost-report linkage is resolved. Any failure blocks release.
05
Licensed clinical reviewer release
A licensed clinical reviewer (e.g., RN, SLP, or psychologist) reviews the exception queue and signs the release. High-dollar or complex claims route to attorney review first.
06
Delivery
You receive the claim pack: claim forms, audit file, evidence log, provider matrix, consent checklist, and cost-report substantiation — ready for the district to submit under its own name.
The bar we hold
Rigor you can measure.
100%
Licensed-reviewer-released
No claim pack ships without a human clinical signature.
5 days
Standard SLA
From complete intake to released claim pack.
<1%
Critical-defect target
Tracked against a gold-standard claim library.
4
Verification sources
State Medicaid · provider licensing board · IEP system · parental consent records, every applicable file.
Why ScholarClaim
Built to be the most thorough option a district has.
Documentation-complete, by design
The deliverable is completeness itself — every claim element and verification accounted for or explicitly exception-coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a regulatory requirement.
In its lane, on purpose
We prepare documentation and run verifications as your clerical agent. We never contact students or families, give legal advice, or submit claims on your behalf.
Engagement
Flat fee, per released claim pack. No contingency, ever.
Simple, predictable, and aligned with a documentation standard — not a cut of any reimbursement.
- A free Documentation Gap Scan before you commit — see exactly what is missing.
- One flat fee per released Claim Completeness Pack; disclosed pass-through verification fees.
- Optional fixed-fee attorney review for high-dollar or complex claims.
- Optional Audit Continuity Add-on for the cost-report and audit-defense exhibits, pre-dated to your claim period.
FAQ
Questions, answered precisely.
Is ScholarClaim a law firm?
No. ScholarClaim, a service of Your Deputy, Obuke LLC, provides documentation-completeness services. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Attorney review is available and recommended for high-dollar or complex claims.
Do you contact students or families or submit claims?
Never. ScholarClaim does not contact students, families, or submit claims to Medicaid. The district remains the claimant and the party responsible for submitting all claims and responding to audits.
What makes a claim pack 'complete'?
Completeness is defined by federal and state rules: the five §440.180(b) claim elements present, provider licensure verified, parental consent and eligibility confirmed, cost-report linkage established, and audit trail complete. Deterministic gates enforce each one before release.
How fast is it?
The standard SLA is five business days from complete intake to a licensed-reviewer-released claim pack. The free Gap Scan is returned much sooner and tells you exactly what is still needed.
How are you priced?
A flat fee per released claim pack, plus disclosed pass-through verification costs. No contingency and no percentage of any reimbursement amount.
See what's missing before it costs you a disallowance.
Start with a free Documentation Gap Scan. Send your service logs, IEPs, and provider files and we'll return a completeness read against every subsection of 42 CFR §440.180.
Documentation-completeness service · not legal advice · the district submits every claim.