Early and Periodic Screening, Diagnosis and Treatment
Blue Cross and Blue Shield of North Carolina is committed to ensuring Healthy Blue members receive age-appropriate preventive health services. Every month, primary care physicians (PCPs) are sent a list of panel members who, based on our claims data, may not have received Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services according to schedule. Additionally, we mail information to these members encouraging them to contact their PCP’s office to set up appointments for needed services.
Specific service(s) needed for each member are reported on the list. Only services received during the time the member has been enrolled with us will appear on the list. The list is generated based on claims data received prior to the date printed on the list, and 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.
Furthermore, 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 that should be considered when evaluating records after a child has been vaccinated.
Review your Provider Manual for more information on the EPSDT program or contact your local Provider Relations representative.
Provider tools & resources
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- Prior authorization lookup tool
- Prior authorization requirements
- Claims overview
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