HealthWatch/Early and Periodic Screening, …

1 HP provider Relations I N D I A N A H E A L T H C O V E R A G E P R O G R A M S. HealthWatch/Early and Periodic screening , diagnosis , and treatment provider Manual L I B R A R Y R E F E R E N C E N U M B E R : P R P R 1 0 0 0 5. R E V I S I O N D A T E : M A R C H 2 0 1 0. V E R S I O N : 6 . 0. Library Reference Number: PRPR10005. Document Management System Reference: HealthWatch/Early Periodic screening , diagnosis and treatment provider Manual (7167). Address any comments concerning the contents of this manual to: HP provider Relations 950 North Meridian Street, Suite 1150. Indianapolis, IN 46204. Fax: (317) 488-5169.

2 2010 Hewlett-Packard Development Company, LP. Current Dental Terminology (CDT ) is copyrighted by the American Dental Association. 2009, 2010 American Dental Association. All rights reserved. Current Procedural Terminology (CPT ) is copyright 2008 American Medical Association. CPT is a registered trademark of the American Medical Association. All rights reserved. Other products and brand names are the trademarks of their respective owners. HealthWatch/EPSDT provider Manual Revision History Document Revision Date Reason for Revisions Revisions Completed Version Number By Version February 2002 New Format EDS Publications Version July 2002 Second Quarter 2002 Update EDS Client Services Department Version December 2003 Quarterly Update EDS Publications Version October 2006 Quarterly Update.

3 Verified forms. Publications Unit, Added Web links. provider Relations Version October 2007 Semiannual Update Publications Unit, provider Relations Version April 2008 Semiannual Update Publications Unit, provider Relations Version August 2008 Semiannual Update Publications Unit, provider Relations Version March 2009 Semiannual Update Publications Unit, provider Relations Version October 2009 Semiannual Update Publications Unit, provider Relations Version March 2010 Semiannual Update Publications Unit, provider Relations Replaced EDS references with HP. Updated the Hoosier Healthwise section Updated the General VFC.

4 Billing Information section Updated the Fee-for-Service Claims Submitted with Place of Service 20-26 section Updated the Prenatal Care Coordination section Updated the Healthy Families section Added the Prenatal Substance Use Prevention Program section Updated the Northwest Indiana Healthy Start section Library Reference Number: PRPR10005 iii Revision Date: March 2010. Version: HealthWatch/EPSDT provider Manual Table of Contents Section 1: Introduction .. 1-1. Overview .. 1-1. Contact Information .. 1-1. Section 2: Program Eligibility .. 2-1. Introduction .. 2-1. Hoosier Healthwise .. 2-1. Care Select .. 2-2.

5 Primary Medical Providers .. 2-3. Service 2-4. Program Financing .. 2-5. PMP Authorization and Prior Authorization .. 2-5. For More Information about Managed Care Networks .. 2-6. Non-Managed Care Members .. 2-6. Section 3: HealthWatch and EPSDT Information .. 3-1. HealthWatch screening Examinations .. 3-1. screening Components and Higher Reimbursement .. 3-1. General Billing Information .. 3-1. Specific Billing Procedures .. 3-2. Examination Procedure and diagnosis 3-2. Reimbursement .. 3-3. Periodicity and Immunization Schedule .. 3-3. Immunization and Screen Billing Procedures .. 3-3. HealthWatch/EPSDT Codes.

6 3-4. Third-Party Liability .. 3-4. Prior Authorization .. 3-4. Vaccines for Children .. 3-4. General VFC Billing Information .. 3-5. Forms for Vaccines for Children (VFC) .. 3-7. Vaccine Storage .. 3-8. Contact Information .. 3-8. Vaccine Stock Availability .. 3-8. Third-Party Liability Billing .. 3-8. Billing Vaccines Other Than VFC .. 3-9. Immunizations and Screenings .. 3-9. diagnosis 3-10. Billing for HealthWatch/EPSDT Visits and Office Visits at the Same Time3-10. Missed Appointment Procedures .. 3-10. Federally Qualified Health Centers and Rural Health Clinics .. 3-11. Section 4: Required HealthWatch/EPSDT Referrals and Screenings.

7 4-1. Dental Observation and screening .. 4-1. Vision Observation and screening .. 4-3. Hearing Observation and screening .. 4-4. Lead 4-5. Indiana's First Steps Program .. 4-8. Children's Special Health Care Services (CSHCS).. 4-9. Section 5: Documentation Resources .. 5-1. Bright Futures .. 5-1. Indiana State Department of Health .. 5-1. American Academy of 5-2. Library Reference Number: PRPR10005 v Revision Date: March 2010. Version: Table of Contents HealthWatch/EPSDT provider Manual Centers for Disease Control and Prevention, National Center for Health Statistics .. 5-2. Section 6: Recommended screening Techniques.

8 6-1. Family and Medical History Documentation .. 6-1. Assessment of Physical and Mental Health Development .. 6-2. Physical Examination .. 6-2. Audiological High Risk Register .. 6-5. Dental Observation and screening .. 6-7. Newborn screening .. 6-8. Section 7: Anticipatory Guidance .. 7-1. Overview .. 7-1. Dental .. 7-1. Dental Anticipatory Guidance for Parents .. 7-1. Preventing Baby Bottle Tooth 7-2. Developmental and Behavioral 7-2. Assessing Development .. 7-2. Children Younger Than 5 Years Old .. 7-2. Assessing Behavior and Mental Health .. 7-5. Adolescent Maturation .. 7-5. Pelvic Exams .. 7-5. STD screening .

9 7-5. HIV Testing .. 7-6. Additional Coding 7-6. Substance Abuse 7-7. Anticipatory Guidance .. 7-7. Anticipatory Guidance Regarding Lead Poisoning for Pregnant Women and Children 6 Years Old or Younger .. 7-7. Section 8: Ruling Out Specific Conditions .. 8-1. Elevated Blood Lead .. 8-1. Interpretation of Blood Lead Test Results and Follow-up Activities .. 8-1. Sickle Cell 8-1. Tuberculosis .. 8-2. Iron Deficiency Anemia .. 8-3. Standards for Further Evaluation .. 8-3. Urinalysis screening .. 8-5. Urinary Albumin and Sugar Testing and Referral Standards .. 8-5. Bacteriuria Testing and Referral Standards .. 8-5.

10 Appendix A: Periodicity and screening Schedule .. A-1. Appendix B: Summary of HealthWatch/EPSDT Codes (not all inclusive)B-1. Appendix C: CMS-1500 Claim Form .. C-1. Appendix D: Children's Programs in Indiana .. D-1. Health-Related Programs .. D-1. Indiana Health Coverage Programs .. D-1. Hoosier Healthwise (Medicaid and Children's Health Insurance Program)D-1. Care Select .. D-1. HealthWatch/EPSDT .. D-2. Medicaid Rehabilitation Option .. D-2. Waiver Program .. D-2. Prenatal Care Coordination .. D-2. HIV Care Coordination .. D-2. Family Planning .. D-3. vi Library Reference Number: PRPR10005. Revision Date: March 2010.