EPSDT - Well child
EPSDT - Well child, Wellchild Well-child, Staywell - Pediatric Visits
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.
- EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, developmental, and specialty services.
- Early: Assessing and identifying problems early
- Periodic: Checking children's health at periodic, age-appropriate intervals
- Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
- Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and
- Treatment: Control, correct or reduce health problems found.
- For more information on EPSDT, select this External link: Medicaid.gov
System Setting
Best Practice: The System Setting PATIENTGUARANTOR should be set to No.
This controls the default value for the Patient is Guarantor selection in Patient Registration.
Condition Indicator
ANSI Loop 2300 must contain a Condition Indicator for EPSDT, and it must answer the question, "Was an EPSDT referral given to the patient? (Yes or No)".
- NU: Entering NU automatically adds N (No) 300 CRC02 and NU to CRC03
- Using the following Condition Indicators automatically adds Y (Yes) to Loop 2300 CRC02
- AV: Patient refused referral
- S2: Patient is currently under treatment for referred diagnostic or corrective health problems
- ST: Referral to another provider for diagnostic or corrective treatment/scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).
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How to add EPSDT to an Encounter
- On the Modify Charge screen, select EPSDT for the ANSI Field.
- If EPSDT does not exist, it must be added to the Groups of Fields library (Permissions driven). Follow the instructions below or contact Support for assistance.
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- The ANSI Field Group can be added to the Procedure Code Library if it is used on every Claim for that Procedure Code.
- After selecting EPSDT, enter the appropriate Condition Indicator on the Popup.
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Add EPSDT Condition Indicators to Groups of Fields
Libraries > Groups of Fields (You can only see this if you have the appropriate Permission)