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What an audit would throw out

The district can bill Medicaid for the very services these deadlines govern, and most districts underclaim badly — one New York City audit found $431.6 million unclaimed.

The same records answer a second question: would this session survive an audit? Eligibility, NPI, licence valid on the service date, provider type, the IEP window, units against documented minutes — and whether the note actually describes the service that was authorised.

Assessed
26
Billable
16
Would be denied
12

One of those denials passes every rule check — eligible student, licensed provider, correct units, a properly written note — and is still a denial, because the note describes a group session while the IEP authorises individual. No pattern matches a story, which is the whole argument for spending a model call.

Over-billing blocks. Under-billing is surfaced as money the district left behind. Nothing is submitted from here; the export is what a billing vendor ingests.

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