Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)

EPSDT services

Each month, claims data is used to send PCPs a list of members who may not have received EPSDT services according to the 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 that the specific service(s) required for each member are listed. The list is based solely on services received during the members' enrollment period 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. Please submit a completed claim form to ensure accurate tracking of appointments for preventive services.

Services must be rendered on or after the due date in accordance with federal and state EPSDT guidelines. In an effort to increase flexibility in adhering to the complex Childhood Immunization Schedule, the Advisory Committee on Immunization Practices recommends that vaccine doses administered up to four days before the minimum interval or age be considered valid. This does not alter the recommendation for routine vaccination, but rather allows for consideration when evaluating records after a child has been vaccinated.

Review your provider manual for more information on the EPSDT program or contact Provider Services.