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

Healthy Blue is committed to ensuring members receive age-appropriate preventive health services.

EPSDT services

A list of panel members who (based on our claims data) may not have received EPSDT services to date is sent to the PCP each month. Additionally, we mail information to these members encouraging them to contact their PCP’s office to set up appointments for needed services.

Please note, specific service(s) needed for each member is reported on the list. The list is based only on services received during the time the member has been enrolled 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. To ensure accuracy in tracking appointments for preventive services, please submit a completed claim form.

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

The American Academy of Pediatrics & Bright Futures

Healthy Blue ensures the provision of screening, preventive, and medically necessary diagnostic and treatment services for children under age 21 covered under the EPSDT core requirements. Pediatric preventive screenings are provided using the most recent recommendations of the American Academy of Pediatrics (AAP). Bright Futures is a national promotion and prevention initiative led by the AAP to provide evidence-driven guidance for all preventive care screenings and health supervision visits.