Early and Periodic Screening, Diagnostic and Treatment

Anthem Blue Cross and Blue Shield Healthcare Solutions is committed to ensuring members receive age-appropriate preventive health services. Each month, we send PCPs a list of panel members who, based on our claims data, may not have received Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services according to schedule. Additionally, we mail information to these members encouraging them to contact their PCP’s office to set up appointments for needed services.

Please note:

  • The specific service(s) needed for each member is reported on the list. The list is based only on services received during the time the member has been enrolled with us.
  • The list is generated based on our claims data received prior to the date printed on the list. In some instances, the appropriate services may have been provided after the report run date.
  • To assure accuracy in tracking appointments for preventive services, please submit a completed claim form.

Please remember, services must be rendered on or after the due date

Please remember, services must be rendered on or after the due date in accordance with federal and state EPSDT guidelines. In an effort to increase the flexibility of the complicated childhood immunization schedule, the Advisory Committee on Immunization Practices recommends that vaccine doses administered up to four days before the minimum interval or age can be counted as valid. This does not change the recommendation for routine vaccination but rather makes an allowance that should be considered when evaluating records after a child has been vaccinated.

Review your Provider Manual for more information on the EPSDT program or contact your Provider Relations representative.

Related information

Documents

HPV Resources:

Provider tools & resources

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