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

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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. [86]
BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012 “Vaccines for Children” (VFC) Program The federal program “Vaccines for Children” (VFC) provides vaccines at no cost to public and private providers who give immunizations to eligible children, including those enrolled in BadgerCare Plus and Medicaid SSI. County Departments that provide immunizations should submit their claims (including those provided through the VFC program) with the appropriate vaccine procedure code. Only the administration component (and not the vaccine itself) is reimbursed in the VFC Program. BLOOD LEAD SCREENS Group Health Cooperative of Eau Claire may contract for blood lead screens 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. Blood lead screens are covered and reimbursed as follows: TESTING METHOD BLOOD LEAD SCREENS Coding and Reimbursement * In-house testing: Reimbursed 36416: Capillary blood collection (finger, heel-stick, etc.) 83655: Lead testing Not Reimbursed 99000: Lab handling fee will NOT be reimbursed for in-house lead testing. Blood Draw (capillary) and Sent to State Lab of Hygiene for testing: Reimbursed 36416: Capillary blood collection (finger, heel-stick, etc.) 99000: Lab handling fee * Please refer to the ForwardHealth website for the most current coding information. In order to perform on-site blood lead testing, providers must hold a CLIA certificate of waiver (or higher complexity CLIA certification level) and meet the following guidelines: Participate in a proficiency testing (PT) program administered by the Wisconsin State Laboratory of Hygiene (WSLH) or another CMS-approved PT program. This program is currently available at no cost to the participants. For additional information about proficiency testing, contact the Wisconsin State Laboratory of Hygiene at (608) 224-6252. Report all blood lead testing results, regardless of the lead level, to the Wisconsin Children’s Lead Poisoning Prevention Program (WCLPPP) as required. [87]
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BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

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