We are committed to helping our members receive age-appropriate preventive health services. Each month, providers will receive a list of members who, based on claims data, may not have received Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services. We also mail information to these members encouraging them to contact their PCP to schedule appointments for needed services.
The specific service needed for each member is reported on the list. The list is based only on services received during the time the member has been enrolled with Summit Community Care and is generated based on claims data prior to the date printed on the list. In some in¬stances, the appropriate services may have been provided after the list was printed. To assure accuracy in tracking appointments for preventive services, please submit a completed claim.
Please remember, services must be rendered on or after the due date in accordance with federal and state EPSDT guidelines. However, in an effort to increase the flexibility of the childhood immunization schedule, the Advisory Committee on Immunization Practices (ACIP) now recommends that vaccine doses administered up to four days before the minimum interval are considered 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.
For more information on the EPSDT program, review your Provider Manual or contact your Provider Relations representative.