NIGP 95078: Swcap Reimbursement to Gr

NIGP 95078 SWCAP Reimbursement to GR, an Item code, covers specialized financial management and administrative services that state and local education agencies buy to maximize Medicaid reimbursements for school-based health and intervention services. The work involves Fee-for-Service billing administration for medically necessary direct services such as speech-language pathology, occupational therapy, physical therapy, and nursing; Administrative Claiming support for education reimbursement; compliance monitoring and documentation review; staff training and audit assistance; and revenue maximization consulting. Contractors typically operate on a contingency-fee basis, receiving a percentage of actual Medicaid reimbursements recovered by the district rather than fixed fees, and must maintain district ownership of all student data and billing records. School districts are the primary issuing bodies under this code, as they operate school-based Medicaid programs and depend on third-party expertise to navigate reimbursement complexity and recover eligible revenue.

The Dougherty County School System in Georgia posted RFP 010-PUR-2027 on June 1, 2026, requesting proposals for comprehensive Medicaid reimbursement management services with a response deadline of June 25, 2026. The district sought vendors with demonstrated experience administering Medicaid reimbursement for Georgia public school systems and knowledge of Children's Intervention School Services program requirements. Evaluation criteria weighted experience and qualifications in Georgia school-based Medicaid programs at 35 points, quality and completeness of proposed services and technical approach at 30 points, cost proposal and percentage fee structure at 20 points, and references and past performance at 15 points. The contract term was July 1, 2026 through June 30, 2027, with all Medicaid payments flowing directly to the district and the contractor invoicing only after reimbursement receipt.