Peach State Provider Office Manual - Peach State Health Plan ...

HEALTH CHECKGEORGIA HEALTH CHECK SERVICES AND STANDARDSHealth Check, otherwise known as the Early and Periodic Screening, Diagnostic, and Treatment(EPSDT) program, is a program of comprehensive preventive health services available toMedicaid recipients less than 21 years of age and PeachCare for Kids children less than 19 yearsof age. The program is designed to maintain health by providing early intervention to discover andtreat health problems. Health Check is a preventive program that combines diagnostic screeningand medically necessary follow-up care for dental, vision and hearing examinations for eligibleGeorgia members under the age of 21.Georgia Health Check services include:• Outreach and informing• Screening in accordance with the DCH periodicity schedule• Tracking compliance with Health Check requirements• Diagnostic and treatment servicesStandards for providing Health Check services are described below and in the Georgia MedicaidPolicies and Procedures, Health Check Services Manual.Peach State will provide to each PCP on a monthly basis, a list of the PCP’s Health Checkeligible children that have not had an encounter during the initial one hundred and twenty (120)calendar days of Peach State enrollment, and/or are not in compliance with the Health Checkperiodicity schedule.PCPs are required to perform Health Check medical check-ups in their entirety and at therequired intervals. All components of exams must be documented and included in the medicalrecord of each Health Check eligible member. Initial Health Check exams are to be completedwithin ninety (90) days of the initial effective date of membership and within twenty-four (24)hours of birth for all newborns.The frequencies of these visits are as follows:• Ten (10) Health Check exams should be provided from birth through the day before thechild’s second birthday. Eight (8) of those exams should be performed from birth throughthe day before the child’s first birthday. The other two (2) exams should be performed forthe day of the child’s first birthday through the day before the child’s second birthday.• After the child’s second birthday and up to the day prior to the individual’s 21 st birthday, aHealth Check exam should be provided annually or one per calendar yearProvider Services1-866-874-063302/22/201156