Rule Reference

Jurisdiction:

Florida — Agency for Health Care Administration

Effective:

2026-07-28

Approver:

Unapproved. No Florida Medicaid subject-matter reviewer has signed off on this pack.

The program and governing rule are cited. The individual field-level checks below are general school-based Medicaid practice, not provisions read out of the Florida coverage handbook, and are not yet mapped to specific handbook sections.

• Fla. Admin. Code r. 59G-4.035 — Medicaid Certified School Match ProgramGoverning rule for Florida school district Medicaid reimbursement. Establishes that school districts may seek reimbursement for medically necessary services provided or arranged for Medicaid-eligible students, including students entitled to services under IDEA Part B or Part C.
• Florida AHCA — Medicaid Certified School Match ProgramProgram administration, eligible provider types, and current fee schedule.
• Florida AHCA — Medicaid Certified School Match Fee Schedule (2025)Published reimbursement rates. ClaimBridge does not price claims against this schedule yet; it sums the revenue supplied in the uploaded file.
• Florida Department of Education — Medicaid Certified School Match ProgramDistrict-facing program guidance.
• 42 C.F.R. § 447.45 — Timely claims paymentFederal outer limit on the claim filing window. States commonly enforce shorter windows and managed care plans shorter still. ClaimBridge does not evaluate timely filing yet.

Jurisdiction:

North Carolina — not yet sourced

Effective:

2026-07-28

Approver:

Unapproved.

Not a North Carolina rule pack. These are the same general checks applied everywhere, with a state prefix on the rule ids. No North Carolina authority has been consulted. Do not present findings from this pack as North Carolina policy determinations.

• 42 C.F.R. § 447.45 — Timely claims paymentFederal outer limit on the claim filing window. States commonly enforce shorter windows and managed care plans shorter still. ClaimBridge does not evaluate timely filing yet.

Jurisdiction:

Virginia — not yet sourced

Effective:

2026-07-28

Approver:

Unapproved.

Not a Virginia rule pack. These are the same general checks applied everywhere, with a state prefix on the rule ids. No Virginia authority has been consulted. Do not present findings from this pack as Virginia policy determinations.

• 42 C.F.R. § 447.45 — Timely claims paymentFederal outer limit on the claim filing window. States commonly enforce shorter windows and managed care plans shorter still. ClaimBridge does not evaluate timely filing yet.

Every service log row carries a Medicaid ID, a procedure code, and a documentation reference. A missing Medicaid ID is critical; the others are warnings.

An eligibility snapshot exists whose coverage window contains the date of service.

The snapshot covering the service date actually records the student as Medicaid eligible, not merely present.

An active consent record covers the service date, with the signed date on or before and any expiry on or after it.

The provider id on the claim resolves to a row in the provider roster.

The provider's credential is accepted for the billed service type, the provider is marked Medicaid billable, and the service date falls inside the provider's active window.

The student has an IEP service authorization for the service type being billed.

The service date falls inside the IEP window, the billed duration does not exceed the authorized session minutes, and group delivery is only billed where the IEP allows it.

An imported denial matches a reviewed claim, so the denial reason can be worked and the claim prepared for resubmission.

The student is Medicaid eligible on the ride date.

An IEP authorizing specialized transportation covers the ride date.

The district is documented as responsible for the transport.

The ride log records both pickup and dropoff.

A same-day attendance record supports the student being present.

A covered service was delivered the same day, where the rule pack requires it.

That same-day service has no critical claimability findings of its own.