ClaimBridge Audit Packet
FL · Florida demo school-based Medicaid review profile
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Claims reviewed
20
Recoverable revenue
$60,240.00
Revenue at risk
$116,300.00
Transport opportunity
$12,980.00
Conservative demo checks for investor walkthroughs; not legal or billing advice.
critical
$6,420.00
Required claim fields are missing: Missing Medicaid ID for FL-STU-102 on 2025-04-09.
Remediation: Correct the missing claim fields in the source system, attach supporting documentation, and re-stage the claim before submission.
Evidence: service_logs.csv row 3
warning
$6,420.00
Claim does not align cleanly to active IEP service terms: IEP window 2025-01-01 to 2025-12-31, session minutes 45, group allowed true. Claim has 60 minutes and group size 3.
Remediation: Compare the billed service against the active IEP service grid and correct either documentation or billing units.
Evidence: service_logs.csv row 3; iep_services.csv row 3
critical
$5,980.00
Provider credential or billable status needs review: Christine Adams has credential PTA, active window 2025-01-01 to 2025-02-28, and Medicaid billable status true.
Remediation: Verify provider credential status and Medicaid billable designation for the service date before resubmission.
Evidence: service_logs.csv row 4; provider_roster.csv row 4
warning
$5,980.00
Claim does not align cleanly to active IEP service terms: IEP window 2025-01-01 to 2025-03-31, session minutes 30, group allowed false. Claim has 45 minutes and group size 1.
Remediation: Compare the billed service against the active IEP service grid and correct either documentation or billing units.
Evidence: service_logs.csv row 4; iep_services.csv row 4
warning
$4,110.00
Required claim fields are missing: Missing procedure code, documentation reference for FL-STU-104 on 2025-04-11.
Remediation: Correct the missing claim fields in the source system, attach supporting documentation, and re-stage the claim before submission.
Evidence: service_logs.csv row 5
critical
$4,110.00
Provider credential or billable status needs review: Angela Davis has credential LCSW, active window 2025-01-01 to present, and Medicaid billable status false.
Remediation: Verify provider credential status and Medicaid billable designation for the service date before resubmission.
Evidence: service_logs.csv row 5; provider_roster.csv row 5
critical
$5,010.00
Provider credential or billable status needs review: Temporary Contractor has credential SLP-Intern, active window 2025-03-01 to present, and Medicaid billable status false.
Remediation: Verify provider credential status and Medicaid billable designation for the service date before resubmission.
Evidence: service_logs.csv row 11; provider_roster.csv row 9
critical
$6,190.00
Provider credential or billable status needs review: Christine Adams has credential PTA, active window 2025-01-01 to 2025-02-28, and Medicaid billable status true.
Remediation: Verify provider credential status and Medicaid billable designation for the service date before resubmission.
Evidence: service_logs.csv row 12; provider_roster.csv row 4
critical
$4,480.00
Provider credential or billable status needs review: Angela Davis has credential LCSW, active window 2025-01-01 to present, and Medicaid billable status false.
Remediation: Verify provider credential status and Medicaid billable designation for the service date before resubmission.
Evidence: service_logs.csv row 13; provider_roster.csv row 5
warning
$4,480.00
Claim does not align cleanly to active IEP service terms: IEP window 2025-01-01 to 2025-12-31, session minutes 30, group allowed true. Claim has 45 minutes and group size 2.
Remediation: Compare the billed service against the active IEP service grid and correct either documentation or billing units.
Evidence: service_logs.csv row 13; iep_services.csv row 13
warning
$5,660.00
Claim does not align cleanly to active IEP service terms: IEP window 2025-01-01 to 2025-12-31, session minutes 30, group allowed true. Claim has 45 minutes and group size 2.
Remediation: Compare the billed service against the active IEP service grid and correct either documentation or billing units.
Evidence: service_logs.csv row 14; iep_services.csv row 6
critical
$7,340.00
Required claim fields are missing: Missing Medicaid ID for FL-STU-106 on 2025-04-21.
Remediation: Correct the missing claim fields in the source system, attach supporting documentation, and re-stage the claim before submission.
Evidence: service_logs.csv row 15
warning
$4,890.00
Claim does not align cleanly to active IEP service terms: IEP window 2025-01-01 to 2025-12-31, session minutes 30, group allowed false. Claim has 30 minutes and group size 2.
Remediation: Compare the billed service against the active IEP service grid and correct either documentation or billing units.
Evidence: service_logs.csv row 19; iep_services.csv row 11
warning
$6,020.00
Required claim fields are missing: Missing procedure code for FL-STU-111 on 2025-04-24.
Remediation: Correct the missing claim fields in the source system, attach supporting documentation, and re-stage the claim before submission.
Evidence: service_logs.csv row 20
critical
$6,020.00
Provider credential or billable status needs review: Christine Adams has credential PTA, active window 2025-01-01 to 2025-02-28, and Medicaid billable status true.
Remediation: Verify provider credential status and Medicaid billable designation for the service date before resubmission.
Evidence: service_logs.csv row 20; provider_roster.csv row 4
critical
$4,290.00
Provider credential or billable status needs review: Angela Davis has credential LCSW, active window 2025-01-01 to present, and Medicaid billable status false.
Remediation: Verify provider credential status and Medicaid billable designation for the service date before resubmission.
Evidence: service_logs.csv row 21; provider_roster.csv row 5
warning
$6,420.00
Remittance denial can be remediated: MISSING_MEDICAID_ID: Recipient Medicaid identifier missing from submitted claim.
Remediation: Resolve the denial reason, attach corrected evidence, and prepare the claim for resubmission review.
Evidence: service_logs.csv row 3; remittance_denials.csv row 2
warning
$4,110.00
Remittance denial can be remediated: MISSING_PROC_CODE: Procedure code is missing or invalid for service.
Remediation: Resolve the denial reason, attach corrected evidence, and prepare the claim for resubmission review.
Evidence: service_logs.csv row 5; remittance_denials.csv row 3
warning
$7,340.00
Remittance denial can be remediated: MISSING_MEDICAID_ID: Recipient Medicaid identifier missing from submitted psychology claim.
Remediation: Resolve the denial reason, attach corrected evidence, and prepare the claim for resubmission review.
Evidence: service_logs.csv row 15; remittance_denials.csv row 4
warning
$6,020.00
Remittance denial can be remediated: MISSING_PROC_CODE: Procedure code is missing from PT claim.
Remediation: Resolve the denial reason, attach corrected evidence, and prepare the claim for resubmission review.
Evidence: service_logs.csv row 20; remittance_denials.csv row 5
warning
$5,010.00
Remittance denial can be remediated: PROVIDER_NOT_BILLABLE: Rendering provider was not enrolled or marked billable for the service date.
Remediation: Resolve the denial reason, attach corrected evidence, and prepare the claim for resubmission review.
Evidence: service_logs.csv row 11; remittance_denials.csv row 6
Aiden Rivera · Route 7 - Specialized East
Claimable
IEP, ride, and same-day service evidence aligned.
Liam Johnson · Route 3 - Mobility Support
Needs review
Same-day service has critical claimability findings.
Sophia Nguyen · Route 4 - West
Needs review
IEP does not document specialized transportation as a related service. Same-day service has critical claimability findings.
Noah Martinez · Route 9 - North Specialized
Claimable
IEP, ride, and same-day service evidence aligned.
Mason Clark · Route 12 - Medical Support
Claimable
IEP, ride, and same-day service evidence aligned.
Lucas Garcia · Route 2 - OT Access
Claimable
IEP, ride, and same-day service evidence aligned.
Ethan Moore · Route 3 - Mobility Support
Needs review
Same-day service has critical claimability findings.
Mason Clark · Route 12 - Medical Support
Claimable
IEP, ride, and same-day service evidence aligned.
Ethan Moore · Route 3 - Mobility Support
Needs review
Ride log does not show both pickup and dropoff. Same-day service has critical claimability findings.