Healthchek: Ohio’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program

Healthchek is Ohio’s early and periodic screening, diagnosis, and treatment (EPSDT) and pregnancy related services program package for babies, children, and young adults under the age of 21 who are enrolled in Ohio Medicaid.

Healthchek services

Healthchek covers 10 check‐ups throughout the first two years of life, then one check‐up each year until the age of 21. Individuals younger than age 21 who are covered by Ohio Medicaid can receive important preventive services through Healthchek, including:

  • Physicals
  • Hearing, vision, and dental screenings
  • Nutritional screenings
  • Mental health screenings
  • Developmental screenings
  • Vaccinations
  • Blood lead screenings

For more information about Healthchek, you can call the Ohio Medicaid Consumer Hotline at 800-324-8680 and speak with a Customer Service representative or visit the Ohio Medicaid Healthchek webpage.

Ensuring members receive service

Anthem Blue Cross and Blue Shield (Anthem) is committed to ensuring members receive age-appropriate preventive health services. To make sure every member is receiving the best care, Anthem is devoted to monitoring the referrals to services and specialty providers that can result from EPSDT screening visits to ensure members obtain services for which they are referred.

Each month, we send PCPs a list of panel members who, based on our claims data, may not have received or are overdue for 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 ensure accuracy in tracking appointments for preventive services, please submit a completed claim form
     

Tracking screenings and referrals

Anthem’s Quality and Provider Experience teams track EPSDT screenings and referrals to ensure those screenings are completed for members as well as ensure members with identified needs through the screening process are linked to medically necessary services. For more information on Healthchek and the EPSDT services Anthem offers, please review your provider manual or contact your Provider Experience representative.

Immunizations covered by Vaccines for Children (VFC)

Anthem providers who administer vaccines to children through 18 years of age should enroll in the VFC program. The Vaccines for Children program is a federally funded program that supplies vaccines at no cost to public and private healthcare providers who enroll and agree to immunize eligible children at their medical practice or clinic.

Note: Anthem will reimburse only the administration fee for any vaccine available through the VFC program. When billing immunizations, report the appropriate vaccine CPT code.

Related resources

Improving EPSDT screening for members (coming soon)

Provider tools & resources

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