Child Health Check-Up (formerly EPSDT) - Herman & Associates ...

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Child Health Check-Up Coverage and Limitations HandbookPurpose and Description, continuedChild HealthCheck-UpA Child Health Check-Up is a comprehensive, preventive health screening service.Child Health Check-Ups are performed according to a periodicity schedule thatensures that children have a health screening on a routine basis. In addition, achild may receive a Child Health Check-Up whenever it is medically necessary orrequested by the child or the child’s parent or caregiver.If a child is diagnosed as having a medical problem, the child is treated for thatproblem through the applicable Medicaid program, such as physician, dental andtherapy services.Note: See Chapter 2, page 2-4, of this handbook for the definition of medicallynecessary.Definition of ChildFor the purpose of this program, the term “child” refers to any child who is eligiblefor medical care as defined by Florida Medicaid policy and is enrolled as arecipient to receive those services.Medicaid ChildHealth Check-UpCoordinatorsMedicaid Child Health Check-Up coordinators are located in the area Medicaidoffices. The Child Health Check-Up coordinators provide outreach services torecipients and training to providers to encourage participation in the Child HealthCheck-Up Program.They assist recipients who are not in managed health care plans with schedulingappointments, arranging transportation, and following up on further diagnoses andtreatment services. They assist managed care providers with schedulingappointments and arranging transportation for their recipients for services notcovered by managed care providers.Note: See the Florida Medicaid Provider General Handbook, for the addressesand phone numbers of the area Medicaid offices.CMS-1500 ClaimForm for PaperClaim SubmissionEffective withHIPAAImplementationBeginning with the Health Insurance Portability and Accountability Act (HIPAA)implementation, a Child Health Check-Up must be billed on the CMS-1500 claimform for paper claim submission. Instructions for completing the CMS-1500 claimform for a Child Health Check-Up, are in the Florida Medicaid ProviderReimbursement Handbook, CMS-1500.Note: For electronic claim submission, contact the Medicaid fiscal agent EDIhelp desk at 800-829-0218.1-2 October 2003
Child Health Check-Up Coverage and Limitations HandbookProvider QualificationsEnrollmentRequirementsChild Health Check-Up is a category of service that certain Medicaid providersmay render. To provide Child Health Check-Ups, a provider must be enrolled inMedicaid as a provider with a Category of Service (code 55) for Child HealthCheck-Ups.Who Can ProvideChild HealthCheck-Up ServicesThe following provider types may enroll as Child Health Check-Up providers:Providers:• Advanced registered nurse practitioners (ARNPs)• Health Maintenance Organizations (HMOs)• Licensed Midwives*• Medical physicians• Osteopathic physicians• Physician assistantsFacilities:• Birthing Centers*• Children’s Medical Services clinics• County health departments• Federally qualified health centers• Hospitals (outpatient only)• Rural health clinics• School Districts*Birthing Centers and Licensed Midwives are limited to the newborn evaluationonly.October 2003 1-3
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Jeb BushGovernorRhonda M. Medows, M
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