Business Details
33 Years
experience
Your Trusted Partner for Medicaid Billing Solutions
Paradigm Healthcare Services has been a trusted leader in school-based Medicaid billing since 1993. We specialize in helping educational institutions recover over $100 million annually through federal reimbursements while ensuring compliance with complex regulatory requirements. Our team of experts combines decades of experience in public health, education, and technology to deliver audit-ready programs that support student wellness initiatives. We pioneered California's first school-based Medicaid billing program and continue to innovate through our proprietary Student Health Network platform. Our commitment to ethical practices and personalized support has made us the preferred partner for schools seeking to maximize funding for health services.We provide comprehensive solutions including direct service billing, administrative claiming, and CYBHI program support. Our technology-driven approach streamlines Medicaid reimbursement processes while maintaining strict adherence to HIPAA and FERPA regulations. With a proven track record of successful program implementation across California, we focus on creating sustainable systems that benefit both educational institutions and the communities they serve. Our dedicated account managers work closely with clients to ensure optimal program performance and compliance. Through continuous innovation and client collaboration, we help schools transform Medicaid funding into improved health outcomes for millions of children.
Services
Billing for Direct Services
School-Based Administrative Claiming
CYBHI Supporting Services
Student Health Network
Student Wellness Module
Details
- Year established: 1993
Highlights and features
- We have over 30 years of experience in school-based Medicaid billing
- Our proprietary Student Health Network platform ensures HIPAA compliance
- Dedicated account managers provide personalized program support
- Proven track record recovering $100M+ annually for clients
- Pioneers of California's first school-based Medicaid billing program
What people say
Fantastic job
Helping kids
Win-win
Increased billing
Dedicated support
Services
Billing for Direct Services
Our direct service billing solution processes daily billing logs and ensures accurate Medi-Cal claims submission for school health services. We provide comprehensive training, audit support, and CRCS services to maximize reimbursement while maintaining compliance. Our system tracks all student health services in one centralized platform.
School-Based Administrative Claiming
We offer complete MAA claiming services including data extraction, eligibility determination, and audit preparation. Our proprietary algorithms optimize reimbursement potential while ensuring compliance with state and federal regulations. We provide quarterly RMTS coding analysis and customized documentation tools.
Student Health Network
Our HIPAA-compliant SHN platform centralizes student health records and billing data. It features integrated ICD-10 coding, real-time reporting, and secure documentation storage. The system streamlines Medicaid billing while supporting comprehensive student wellness management.
CYBHI Supporting Services
We provide specialized billing expertise for California's Child & Youth Behavioral Health Initiative. Our services include program implementation, compliance monitoring, and integration with existing Medicaid billing systems to maximize funding for behavioral health services.
Student Wellness Module
This SHN add-on module supports holistic student wellness management. It enables coordinated care planning, tracks behavioral health interventions, and maintains documentation for billing purposes while promoting comprehensive student well-being.
People
Constance
OWNER/CEO
30+ years of experience in public agency Medicaid programs. Former U.S. Air Force officer with Masters in Public Health from Boston University. Shaped California Medicaid policy and published extensively on school health programs.
Roger
DIRECTOR, PARADIGM TECHNOLOGIES
15+ years in education IT with UC Berkeley Computer Science degree. Leads technology team developing Medicaid billing solutions that balance compliance requirements with user-friendly design for school administrators.
Kathleen
SPECIAL PROJECTS CONSULTANT
Health science expert with decade of healthcare experience. Manages strategic projects connecting schools and hospitals to support children with special needs through Medicaid-funded programs.
Amber
MANAGER OF ACCOUNTS
Medicaid reimbursement specialist with proven track record increasing client billing success. Develops systems for sustainable program management and compliance with state Medicaid regulations.
Tim
MANAGER, FISCAL SERVICES
20+ years in school accounting. Oversees fiscal data processing and audit preparation for Medicaid claims. Expert in regional, state, and federal audit requirements for educational agency billing programs.
Questions
What Medicaid billing services do you offer for schools?
We provide direct service billing, administrative claiming, and CYBHI program support with dedicated account managers and compliance tools.
How do you ensure billing compliance?
Through audit-ready documentation, proprietary compliance tools, and regular training on changing Medicaid regulations for school programs.
What technology platforms do you use?
Our Student Health Network platform includes Medicaid billing tools, electronic health records, and the Student Wellness Module for behavioral health tracking.
How do you support CYBHI program participation?
We provide specialized billing expertise, system integration, and compliance monitoring to maximize funding for California's behavioral health initiative.
What experience do you have with school Medicaid programs?
Since 1993, we've helped schools recover over $100 million annually through Medicaid reimbursements with our proven compliance and billing systems.
How do you handle audit preparation?
We provide documentation tools, compliance reviews, and on-site support for regional, state, and federal audits of Medicaid billing programs.
