The Pennsylvania Department of Human Services (Commonwealth) and Healthcare
Effectiveness Data and Information Set (HEDIS?) specifications state
that all children enrolled in Pennsylvania's Children's Health Insurance
Program (CHIP) should receive testing for elevated blood lead levels (EBLL) and
developmental screening as recommended below.
Lead testing and developmental screening
recommendations
Practitioners are encouraged to follow the Medicaid and Bright
FuturesTM guidelines for lead testing and developmental screening. A
lead blood test should be completed at ages 9 to 12 months and again before age
24 months. Formal screening for developmental disorders using a standardized
tool, such as the Ages and Stages questionnaire (CPT? 96110), should
be completed for children who turn 1, 2, or 3 years of age or when surveillance
yields concern. This is especially important for children enrolled in CHIP
because of the higher incidence of developmental delay among certain pediatric
populations enrolled in government sponsored programs when compared to children
enrolled in privately insured plans.
CHIP members should meet the Medicaid guidelines for lead testing and
developmental screening regardless of risk level. We know many provider
practices have already performed these tests, and we thank you and your staff
for the care you provide to our pediatric and CHIP members.
What your practice can do
To help ensure your members receive the required testing, your practice can
do the following:
- Screen children for EBLL by performing a risk assessment at 6 months, 9
months, 18 months, and then annually from ages 3 – 6 with testing as
appropriate.
- Perform developmental surveillance at each well-child visit and document
the use of a standardized developmental screening tool for children who turn 1,
2, or 3 years of age or when surveillance yields concern.
- Discuss recommendations for lead testing and developmental screening with
the parents/guardians of your CHIP patients.
Identifying CHIP members
To help your practice easily identify CHIP members, we include the
identifying words “PA Kids” on the front of Independence ID cards,
as shown in the sample CHIP ID card below.
Reminder: PROMISeTM ID
required to render services to CHIP members
The state of Pennsylvania requires a Provider Reimbursement and Operations
Management Information System (PROMISe) ID for all providers who
render services to CHIP members. There are a few important things about
PROMISe IDs to keep in mind:
- DHS implemented the Affordable Care Act provision that requires all
providers who render services to CHIP members be enrolled with DHS as a CHIP
provider.
- Upon enrollment, DHS will issue providers a PROMISe identification
number.
- The deadline for CHIP providers to enroll with DHS was December 31, 2017.
However, you may still enroll.
- Remember, registering as a CHIP-only provider does not
mean providers must accept Medical Assistance beneficiaries.
- In the near future, a PROMISe ID will be required to receive
payment from Independence for services rendered to CHIP members. This date will
be communicated once determined by the Office of CHIP.
- As of the determined date, claims submitted to Keystone Health Plan East by
a non-enrolled provider (i.e., one without a PROMISe ID) will not
receive payment.
- Visit the DHS website to access the application, requirements, and
step-by-step instructions related to the enrollment process.
Resources
The following resources provide additional information regarding lead
testing recommendations:
HEDIS is a registered trademark of the National Committee
for Quality Assurance (NCQA). Used with permission.
CPT Copyright 2017 American Medical Association. All
rights reserved. CPT? is a registered trademark of the American
Medical Association.
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