BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012
HealthCheck Schedule
Primary Care Providers are required by DHS to achieve 80% of all Health Checks for their BadgerCare Plus
patients. The State has established the following periodicity schedule, consistent with the 1988 American
Academy of Pediatrics recommendations:
Birth to first birthday: six screenings
First birthday to second birthday: three screenings
Second birthday to third birthday: two screenings
Third birthday to sixth birthday: one screening per year
Sixth to twenty-first birthday: one screening every other year
Coordination of Care with Primary Care Providers
Contracted County Departments can submit claims for components of the HealthCheck exam (i.e.
immunizations, blood lead testing, dental fluoride varnish and hemoglobin/ hematocrit testing) without a
Memorandum of Understanding (MOU) between the County and Primary Care Clinic (PCC). However, if
the County Department submits claims for HealthCheck Exams, a signed MOU between the County and
primary care provider should be in place, stating that they will coordinate the client’s care, share information
appropriately and avoid the duplication of services. The Primary Care Clinic receives compliance credit for
any HealthCheck exams completed by the County.
Note: Group Health Cooperative does not require that the provider (PCC) sign an MOU with the County
Department and leaves the negotiations regarding this MOU between the two entities. Also, the decision to
coordinate care and how this will be done is strictly between the Primary Care Provider and the County.
IMMUNIZATIONS & VACCINES
Group Health Cooperative of Eau Claire may contract for immunizations and vaccines provided by the County.
Please refer to the Provider Services Agreement to determine if these services will be reimbursed by Group
Health Cooperative of Eau Claire.
Covered Vaccines
BadgerCare Plus covers the preventive vaccines which are normally covered under HealthChecks. For a
complete list of covered vaccines, corresponding codes and immunization schedules please refer to the
ForwardHealth website at: http://www.forwardhealth.wi.gov
Certain vaccines that are commonly combined, such as MMR or DTaP, are not reimbursed separately unless
there is a medically necessary reason to administer each vaccine separately, which is documented in the
member's medical record.
BadgerCare Plus (Standard, Benchmark and Core Plans) provide full coverage with no copayment for
immunizations.
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