eSHARS Business Overview

What is eSHARS?

eSHARS (Electronic School Health and Related Services) is a web-based software platform that helps Texas school districts get reimbursed by Medicaid for health services they provide to special education students.

In simple terms: Schools provide therapy and health services to students with disabilities. These services are eligible for Medicaid reimbursement. eSHARS is the system that documents these services, verifies eligibility, submits claims, and tracks payments.

The Business Problem We Solve

The SHARS Program

Texas has a program called SHARS (School Health and Related Services) that allows school districts to bill Medicaid for certain health-related services provided to special education students. This can represent millions of dollars in revenue for school districts.

The Challenge

To get reimbursed, districts must:

Document every service with specific compliance requirements
Verify each student is Medicaid-eligible before billing
Submit claims to Texas Medicaid (TMHP) in the correct format
Track what gets paid and handle denials
Maintain audit-ready records for federal/state reviews
Ensure providers have proper credentials

Without a system like eSHARS, this would require enormous manual effort and districts would likely miss revenue opportunities or face compliance issues.

Our Value Proposition

eSHARS automates and streamlines this entire process, helping districts:

Maximize revenue by capturing all billable services
Stay compliant with built-in validation rules
Reduce administrative burden through automation
Pass audits with comprehensive documentation

Who Uses eSHARS?

Primary Users

User Type	What They Do	Key Needs
Clinicians/Therapists	Deliver services to students (Speech, OT, PT, etc.)	Easy way to document visits, manage their student caseload
District SHARS Coordinators	Oversee SHARS program for their district	Visibility into compliance, ability to manage users and settings
Supervisors	Review and approve clinician work	Efficient approval workflows
Finance Staff	Track revenue and manage billing	Invoice management, payment tracking, reporting

User Scale

90-100 Texas school districts currently use eSHARS
Districts range from small rural ISDs to large urban districts like Houston ISD
Each district has multiple campuses (schools) and many providers
Competitive market: Districts may switch vendors based on pricing; some come and go as competitors offer similar services

What Services Are Billable?

The following health services, when provided to special education students, can be billed to Medicaid:

Service Category	Examples
Speech Therapy	Speech-language pathology services
Occupational Therapy (OT)	Fine motor skills, sensory processing
Physical Therapy (PT)	Gross motor skills, mobility
Psychological Services	Counseling, psychological evaluations
Nursing Services	School nurse services, medical procedures
Audiology	Hearing evaluations and services
Personal Care	Assistance with daily living activities
Special Transportation	Transport to/from school for students requiring it

Key Features & Workflows

1. Visit Documentation (The Core Workflow)

What it is: Clinicians document every service session (“visit”) they provide to a student.

Why it matters: Each documented visit is a potential Medicaid claim worth money to the district.

How it works:

Clinician logs in and sees their caseload (assigned students)
They select a student and create a visit record
They enter: date, service type, duration, goals addressed, session notes
The system validates the visit (Is the student eligible? Does consent exist? Are there hours remaining in the IEP?)
Clinician releases the visit for supervisor review
Supervisor approves the visit
Visit becomes billable

2. ARD/IEP Hour Tracking

What it is: Each special education student has an IEP (Individualized Education Program) that specifies how many hours of each service they should receive.

Why it matters:

We can only bill for services that are in the student’s IEP
We must track hours to ensure we don’t exceed allocations
This is a key compliance requirement

How it works:

When ARD (IEP meeting) data is entered, service hours are allocated
As visits are documented, remaining hours are calculated
System warns/blocks if hours would be exceeded

3. Medicaid Eligibility Verification

What it is: Before we can bill Medicaid for a student, we must verify they are currently Medicaid-eligible.

Why it matters: Billing for ineligible students = claim denial + potential fraud issues.

How it works:

System sends 270 eligibility requests to TMHP (Texas Medicaid)
TMHP responds with 271 eligibility responses
System updates each student’s eligibility status
Only visits for eligible students can be billed

4. Billing & Claims Submission

What it is: Approved, eligible visits are bundled into billing transactions and submitted to Medicaid.

Why it matters: This is how districts actually get paid.

How it works:

System collects all billable visits
Validates billing rules (correct codes, within limits, etc.)
Generates claim files in required EDI format
Submits to TMHP
Receives remittance (payment) information
Updates visit payment status

5. Appeals

What it is: When a visit is denied or rejected, clinicians can submit an appeal.

Why it matters: Recovered revenue from successful appeals.

How it works:

Visit gets denied (by supervisor or by Medicaid)
Clinician submits appeal with justification
Supervisor/admin reviews and approves or rejects
If approved, visit goes back into billing cycle

6. Finance & Revenue Tracking

What it is: Track invoices, payments, and overall revenue.

Why it matters: Districts need to know what they’re owed and what they’ve received.

Key reports:

Revenue by campus
Revenue by district
Cost reports for Medicaid
Receivables and payment status

7. Signature Authorization (SA Forms)

What it is: Providers must annually sign authorization forms attesting to their credentials.

Why it matters: Compliance requirement - can’t bill for services from unauthorized providers.

The Data Hierarchy

eSHARS organizes data in a hierarchy:

Texas State (Top Level)
    └── Districts (e.g., Houston ISD, Alvin ISD)
            └── Campuses (individual schools)
                    └── Students & Providers

State level: Global configuration, services, qualifications
District level: District-specific settings, EDI configuration, users
Campus level: Schools within the district
Student/Provider level: Individual records

This allows:

Central management of common settings
District-specific customization where needed
Campus-level organization for daily operations

Key Compliance Requirements

What We Must Track

Requirement	Why	How eSHARS Helps
Parental Consent	Can’t bill without parent permission	Tracks consent dates, blocks billing without consent
Medicaid Eligibility	Can only bill for eligible students	Automated eligibility verification
IEP/ARD Hours	Services must be in the IEP	Tracks allocations and remaining hours
Provider Credentials	Providers must be qualified	Tracks qualifications, certificates, licenses
Documentation	Must have complete visit records	Structured visit entry with required fields
Audit Trail	Must show who did what and when	Complete audit logging of all changes

Regulatory Context

HIPAA: Student health information is protected
FERPA: Student educational records are protected
Medicaid/False Claims Act: Billing must be accurate and supported

Integration Points

eSHARS connects with external systems:

System	Purpose
TMHP (Texas Medicaid & Healthcare Partnership)	Eligibility verification, claims submission, payment receipt
Centricity	Import payment data from another billing system
Adobe Sign	Electronic signatures for authorization forms

Key Metrics & Success Measures

How districts measure SHARS program success:

Metric	Description
Visit Capture Rate	Are all billable services being documented?
Eligibility Rate	What % of students are Medicaid-eligible?
Billing Success Rate	What % of claims are paid vs. denied?
Revenue per Student	Average Medicaid revenue per eligible student
Compliance Score	Are all requirements being met?

Summary: The eSHARS Value Chain

1. SETUP
   Students enrolled → Services assigned → ARD hours allocated
                                    ↓
2. SERVICE DELIVERY
   Clinician provides therapy → Documents visit in eSHARS
                                    ↓
3. APPROVAL
   Supervisor reviews → Approves visit
                                    ↓
4. ELIGIBILITY
   System verifies Medicaid eligibility
                                    ↓
5. BILLING
   Visit included in billing transaction → Submitted to TMHP
                                    ↓
6. PAYMENT
   Medicaid pays claim → Revenue tracked → District gets reimbursed

Questions to Explore Further

As I continue onboarding, areas I’d like to understand better:

Business Rules: What are the most complex compliance rules?
Pain Points: What do users struggle with most?
Roadmap: What features are planned or requested?
Support: What are the most common support issues?
Competition: Who are the main competitors? What differentiates eSHARS?
Revenue Model: How does AuthenticaTech make money from eSHARS?
Customer Retention: What causes districts to leave or stay?

This overview reflects my current understanding of eSHARS from a business perspective. I’m happy to dive deeper into any area or correct any misunderstandings.