Newsletter Vol. 4, No. 34

By August 1, 2024: Billing team must implement dual-form submission process for all EPSDT preventive child health visits. SPECIFIC ACTIONS: (1) Obtain supply of MC forms from Unisys Provider Services Unit (Quakerbridge Road, Suite 100, Trenton, NJ); (2) Update billing workflow to require completion of BOTH MC form and UB claim form for every Medicaid-eligible patient under 21 receiving EPSDT screening; (3) Update billing system to enforce entry of Clinic Code in UB field FL 24 and Condition Code 'A' in FL 24 to flag EPSDT services; (4) Configure mail routing: send MC form to PO Box [address from policy] and UB form to separate PO Box [address from policy] — DO NOT attach MC to UB; (5) Update encounter forms/templates to require providers to document that service includes EPSDT components; (6) For electronic submissions, ensure system enters Clinic Code and Condition Code 'A' in correct EDI Record Type fields per version being used (Version 4 or UB format); (7) Train billing staff that absence of MC form will cause UB claim to pend or deny — both forms are mandatory; (8) Note: Medically Needy-eligible patients are EXEMPT from EPSDT reporting requirements. RESPONSIBLE PARTY: Billing team, IT/systems staff. CONSEQUENCE: Claims will pend or deny without both MC and UB submission; reimbursement cannot be processed by MMIS without both forms received and entered.