Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Healthy Blue is committed to ensuring members receive age-appropriate preventive health services. A list of panel members who, based on our claims data, may not have received EPSDT services according to schedule is sent to the primary care physicians (PCPs) each month. Additionally, we mail information to these members encouraging them to contact their PCP’s office to set up appointments for needed services.
Please note, 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 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.
In addition, 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 (ACIP) recommends vaccine doses administered up to four days before the minimum interval or age 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.
- Impact of the COVID-19 pandemic on adolescent vaccinations: projected time to reverse deficits in routine adolescent vaccination in the United States
- HPV Vaccination and the Risk of Invasive Cervical Cancer
- Human papillomavirus vaccine efficacy against invasive, HPV-positive cancers: population-based follow-up of a cluster randomized trial
- HPV Vaccination at 9-12 Years of Age
- Starting HPV Vaccination at Age 9
- American Cancer Society resources: HPV Vaccination and Cancer Prevention | ACS
- CDC resources: HPV Resources, Education, and References | CDC
- National HPV Vaccination Roundtable resources: Resource Library – National HPV Roundtable
- Resources for nurses
- HPV Vaccination Resources for Health Professionals
- Steps for Increasing HPV Vaccination in Practice An Action Guide to Implement Evidence-based Strategies for Clinicians
Provider Tools & Resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Eligibility Overview
- Provider Manual and Guides
- Provider Search Tool
- Training Academy
- Electronic Data Interchange (EDI)
- Quality of Care Incident Form