Beginning in March, Healthy Campus is introducing a new Medical Necessity & MTSS Tier Tracking feature to support CYBHI documentation standards and strengthen audit readiness.
This enhancement allows districts to formally document a student’s level of medical necessity (aligned to MTSS tiers) directly within the Student Clearance section of the platform.
While medical necessity documentation is not submitted with claims, CYBHI requires that services be medically necessary and that supporting documentation be maintained in the event of review or audit. This feature ensures that documentation is clearly organized and accessible.
Watch a Video
Introducing Medical Necessity Documentation for CYBHI in Healthy Campus đź“‹
What Is Changing
A new “Medical Necessity – MTSS Tier” indicator will now appear in the Student Clearance section alongside:
Consent to Treat
Consent to Bill
Insurance Information
Initially, this status will display as “Pending.”
Once documented, a green medical necessity flag will appear in the clearance card.
How Medical Necessity Is Documented
Districts can document medical necessity in two ways:
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Upload Supporting Documentation
Upload a screener, assessment, or other file that substantiates the student’s eligibility for services at a specific MTSS tier.
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Reference a Prior Documented Session
Select a previously completed visit.
Open the specific service where documentation occurred.
Confirm that the documented session substantiates the student’s level of medical necessity.
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Mass Upload
If you're collecting this information through some other means, you can work with your Account Manager to export and upload this information into the Healthy Campus Platform.
Once confirmed, the selected tier (e.g., Tier 1, Tier 2, Tier 3) will be recorded in the Medical Necessity tab and reflected in the Student Clearance section -- all found conveniently in the student's Profile.
Medical necessity documentation may be updated over time if a student’s level of support changes.
How Tiers Connect to Reimbursement
Services within Healthy Campus can be assigned an MTSS tier during service creation (by administrators or supervisors).
The system will prevent submission of services for reimbursement if there is no documented medical necessity for the corresponding tier.
This safeguard is designed to:
Protect districts from avoidable denials
Ensure alignment between documented need and billed services
Strengthen compliance under CYBHI
What Is Not Changing
Medical necessity standards under CYBHI remain the same.
Documentation is not automatically submitted with claims.
ORP requirements for Medi-Cal claims remain unchanged.
Existing consent and insurance workflows remain unchanged.
Why This Matters
Under CYBHI, services must be medically necessary, though documentation is maintained at the district level rather than submitted with each claim.
By formally tracking MTSS tier-based medical necessity within the platform, districts gain:
Clear internal documentation structure
Alignment between MTSS frameworks and CYBHI reimbursement
Audit-ready documentation organization
Built-in claim submission safeguards
Have Questions?
If you have questions about implementing Medical Necessity & MTSS Tier Tracking within your district workflow, please contact your Healthy Campus Account Manager or submit a request through the Support tab within the platform.