Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Highmark Blue Cross Blue Shield of Western New York is committed to ensuring members receive age-appropriate preventive health services. A list of panel members who, based on our claims data, may not have received EPSDT services according to the schedule is sent to the primary care physicians (PCPs) 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 is 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 complicated Childhood Immunization Schedule, the Advisory Committee on Immunization Practices (ACIP) 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 to consider when evaluating records after a child was vaccinated.
Review your Provider Manual for more information on the EPSDT program, or contact your Provider Relations representative.
Provider tools and resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Provider manual and guides
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)