EPSDT Information

Provider Resources: EPSDT

The following links are for information regarding Early and Periodic Screening, Diagnostic and Treatment.

**NEW: Pennsylvania's Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule, Updated September 19, 2022

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 Wholecare 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 Wholecare 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.

This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, which is an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 14 counties in western Pennsylvania. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 14 counties in northeastern Pennsylvania, 12 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.

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