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EPSDT



EPSDT Information:
Adolescent Depression Screening
Autism and Developmental Screening Handout
Bright Futures Periodicity Schedule
CDC Immunization schedule
CMS 1500 Claim Form
EPSDT Program Periodicity Schedule and Coding Matrix
Guide to Accessing Provider Portal Reports on Navinet
Information on Provider Portal Reports
Lead Screenings
Maternal Depression Screening
Psychosocial and Social-emotional Screening Tools
Screening for Developmental Delays and Autism
Tobacco, Alcohol or Drug Use Assessment

Provider Manual

The provider manual is reviewed in detail by a provider relations representative with the provider within 30 calendar days of the provider successfully gaining approval to participate in the Highmark Health Options network. The provider manual includes information regarding EPSDT requirements such as Blood Lead Screening, Vaccines for Children, Oral Health Risk Assessment, the EPSDT Program, Review of required screens and tests for the EPSDT population.



Provider Dashboard

In addition to the EPSDT Dashboard, the Provider Dashboard Report serves to provide PCPs detail on their member data as well as creating opportunities to impact key performance indicators in the effective clinical management of the EPSDT population. The Provider Dashboard utilizes claims data to auto-generate a report which provides a network provider a snapshot of their panel of members in the EPSDT population. It is intended to be an aid in program improvement, benchmarking and other quality improvement strategies. A Physician Dashboard Report is provided to all PCPs quarterly indicating individual members that are due or overdue for an EPSDT well-visit.

Physicians and other providers are encouraged to request assistance from Care Coordination staff at Highmark Health Options to telephonically follow-up with members who need additional education or further explanation about issues, such as the importance of keeping scheduled appointments and obtaining referrals forspecialty care. Providers can fax an EPSDT Member Outreach Form to the Organization for the following reasons:

  • Education regarding compliance with recommended testing, such as blood lead level testing
  • Scheduling assistance for EPDST screenings
  • Education about the potential implications of chronically ill members not keeping appointments for preventive appointments, etc.

Need More Information?

Call Provider Services to learn more about our network and how to join at 1-844-325-6251.