TennCare Kids / EPSDT
Thousands of kids from low-income homes in Tennessee miss their annual well-care checkups and that number increases every year. Statewide, about three of every 10 kids enrolled in BlueCare Tennessee do not get the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) they need. We’re working to reverse that trend and we’re asking for your help.
Who is Eligible?
Your patients (ages 20 and younger) covered by BlueCare Tennessee are eligible for well-care visits, including members who need prenatal care services from their obstetricians.
Medical Record Documentation Requirements
Each TennCare Kids checkup should include:
- All seven components of a TennCare Kids examination
- All appointments for other health care, including dental care
- The reason for not performing any component of the examination
- Any service declined by the member
Seven TennCare Kids Screening Components
- Comprehensive health and developmental history;
- Comprehensive unclothed physical examination including measurements
- Appropriate immunizations;
- Appropriate vision and hearing testing;
- Appropriate laboratory tests;
- Dental screening services furnished by direct referral to a dentist for children no later than 3 years of age and should be referred earlier as needed (as early as 6 to 12 months in accordance with the American Academy of Pediatric Dentistry (AAPD) guidelines) and as otherwise appropriate and;
- Health education/anticipatory guidance.
Appointments must be made for other necessary health care, diagnostic services, treatment and other measures to correct, ameliorate, or prevent from worsening defects and mental illnesses and conditions discovered during the screening services, regardless of whether the required services are covered under by the member’s behavioral health organization or managed care organization. When screening reveals the need for other health care and the practitioner is unable to obtain an appointment, he or she must notify BlueCare or TennCare Select Provider Service for assistance with appointment scheduling.
Coordination of Care
Please share the details of any TennCare Kids services or preventive care with the primary care practitioner
(PCP) shown on the member’s ID card to ensure the child’s PCP has a complete record of health for the patient.
To ensure care coordination, PCPs should refer children enrolled in an Individual Education Program (IEP)
and/or Individual Family Service Plan (IFSP) by calling 1-800-468-9698 for BlueCare or 1-800-263-5479 for TennCareSelect
or faxing information to 1-800-421-2885.
If you have a patient who does not have a way to get to an appointment for TennCare Kids services, transportation is available by contacting Southeastrans at the following numbers:
BlueCare – 1-855-735-4660
TennCare Select – 1-866-473-7565
CHOICES/ECF CHOICES – 1-888-747-8955
SelectCommunity – 1-800-292-8196
TennCare Kids Tool Kit
As a network provider, we know that you’re dedicated to improving the health of your patients. Here is TennCare Kids Tool kit to us as we work together on improving the health of kids throughout Tennessee:
Thank you for the care you provide to your patients covered by BlueCare Tennessee. We look forward to working with your practice to improve EPSDT rates across Tennessee.
Resources for Promoting Well-Child Care
We have a dedicated team ready to help you engage and encourage your patients to get the preventive care and screenings they need. We’re right here to help you develop the customized outreach strategy that works best for your patients and practice. To learn more, call 1-800-771-0217.
Inviting Your Patients to the Office
We’ll help you review claims to see which of your patients are due for certain screenings or checkups, mail screening reminders, make personal calls to schedule appointments, and send automated phone messages. We can also share your patient list with you so you can use it to help increase patient screenings in your office.
The links below will take you to resources we’ve prepared to help you when contacting your patients. Outreach Examples includes sample call scripts, text message alerts and social media posts.
The Free Child Checkup flyer is a downloadable, editable PDF that you can populate with your office or event details, if you’re hosting a community outreach event.